CMS-P0015A English Section by Section HF_10.01.0002

BOX HFBEG

BOX HFBEG

Page Order # :

10

BOX INSTRUCTIONS
( HFQ1010 )

GO TO HFA1 - GENHELTH ( HFQ1020 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:27 PM Thursday, March 28, 2013

Page 1 of 789

HFA1

HFA1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

GENHELTH

Enable Functions:

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Yes

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No
No

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20

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Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now, I would like to ask you about [your/(SP's)] health.
In general, compared to other people [your/(SP's)] age, would you
say that (your/his/her) health is . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:12:28 PM Thursday, March 28, 2013

Page 2 of 789

HFA1

Field1:

GENHELTH

Cheshire Name:

( HFQ1020 )

HEST.GENHELTH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TGenhelth
1
No
No

Number Label
1 Excellent

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFA2 - COMPHLTH ( HFQ1030 )

2

English text: excellent,
VeryGood

HFA2 - COMPHLTH ( HFQ1030 )

3

English text: very good,
Good

HFA2 - COMPHLTH ( HFQ1030 )

4

English text: good,
Fair

HFA2 - COMPHLTH ( HFQ1030 )

5

English text: fair, or
Poor

HFA2 - COMPHLTH ( HFQ1030 )

English text: poor?
Attribute

Route

Don't know

HFA2 - COMPHLTH ( HFQ1030 )

Refusal

HFA2 - COMPHLTH ( HFQ1030 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:12:30 PM Thursday, March 28, 2013

Page 3 of 789

HFA1
DESIGN NOTES

4:12:30 PM Thursday, March 28, 2013

Page 4 of 789

HFA2

HFA2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

COMPHLTH

Enable Functions:

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No
Yes
Yes

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No
No
No
No

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No
No

30

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF

Question Text:

Compared to one year ago, how would you rate [your/(SP's)] health
in general now?
Would you say [your/(SP's)] health is . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:12:31 PM Thursday, March 28, 2013

Page 5 of 789

HFA2

Field1:

COMPHLTH

Cheshire Name:

( HFQ1030 )

HEST.COMPHLTH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TComphlth
1
No
No

Number Label
1 MuchBetter

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFA3 - HELMTACT ( HFQ1040 )

2

English text: much better now than one year ago,
SomewhatBetter
HFA3 - HELMTACT ( HFQ1040 )

3

English text: somewhat better now than one year ago,
AboutTheSame
HFA3 - HELMTACT ( HFQ1040 )

4

English text: about the same,
SomewhatWorse

5

English text: somewhat worse now than one year ago, or
MuchWorse
HFA3 - HELMTACT ( HFQ1040 )

HFA3 - HELMTACT ( HFQ1040 )

English text: much worse now than one year ago?
Attribute

Route

Don't know

HFA3 - HELMTACT ( HFQ1040 )

Refusal

HFA3 - HELMTACT ( HFQ1040 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:12:33 PM Thursday, March 28, 2013

Page 6 of 789

HFA2
DESIGN NOTES

4:12:33 PM Thursday, March 28, 2013

Page 7 of 789

HFA3

HFA3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HELMTACT

Enable Functions:

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No
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Yes

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No
No
No
No

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No
No

35

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "past month" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How much of the time during the past month has [your/(SP's)] health
limited [your/(SP's)] social activities, like visiting with friends or close
relatives?
Would you say . . .

Int. Instr II:

INPUT FIELDS / ROUTING

4:12:34 PM Thursday, March 28, 2013

Page 8 of 789

HFA3

Field1:

HELMTACT

Cheshire Name:

( HFQ1040 )

HEST.HELMTACT

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

Enumerated
THelmtact
1
No
No

Number Label
1 NoneOfTheTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFA1 - (HFQ1045 )

2

English text: none of the time,
SomeOfTheTime

BOX HFA1 - (HFQ1045 )

3

English text: some of the time,
MostOfTheTime

BOX HFA1 - (HFQ1045 )

4

English text: most of the time, or
AllOfTheTime

BOX HFA1 - (HFQ1045 )

English text: all of the time?
Attribute

Route

Don't know

BOX HFA1 - (HFQ1045 )

Refusal

BOX HFA1 - (HFQ1045 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

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4:12:35 PM Thursday, March 28, 2013

Page 9 of 789

BOX HFA1

BOX HFA1

Page Order # :

40

BOX INSTRUCTIONS
( HFQ1045 )

IF THIS IS ROUND 67 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFF1 - (HFQ1290 ).
ELSE GO TO HFB1 - ECHELP ( HFQ1050 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:12:35 PM Thursday, March 28, 2013

Page 10 of 789

HFB1

HFB1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ECHELP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

50

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] wear eyeglasses or contact lenses?

Int. Instr II:

INPUT FIELDS / ROUTING

4:12:36 PM Thursday, March 28, 2013

Page 11 of 789

HFB1

Field1:

ECHELP

Cheshire Name:

( HFQ1050 )

HEST.ECHELP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TEchelp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB2 - ECTROUB ( HFQ1060 )

2

English text: YES
No

HFB2 - ECTROUB ( HFQ1060 )

3

English text: NO
Blind

HFB6 - EDOCEXAM ( HFQ1070 )

English text: SP IS BLIND
Attribute
Don't know

Route
HFB6 - EDOCEXAM ( HFQ1070 )

Refusal

HFB6 - EDOCEXAM ( HFQ1070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:37 PM Thursday, March 28, 2013

Page 12 of 789

HFB2

HFB2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

ECTROUB

Enable Functions:

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No
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Yes

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No
No
No
No

Grid Functions:

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No
No

60

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFB1 - ECHELP = 1/Yes, display "while wearing glasses or
contact lenses".
Else do not display.

Multi Field display:

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

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

Which statement best describes [your/(SP's)] vision (while wearing
glasses or contact lenses): no trouble seeing, a little trouble, a lot of
trouble, or no usable vision?

Int. Instr II:

INPUT FIELDS / ROUTING

4:12:38 PM Thursday, March 28, 2013

Page 13 of 789

HFB2

Field1:

ECTROUB

Cheshire Name:

( HFQ1060 )

HEST.ECTROUB

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTrouble
1
No
No

Number Label
1 NoTroubleSeeing

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB6 - EDOCEXAM ( HFQ1070 )

2

English text: NO TROUBLE SEEING
LittleTroubleSeeing

HFB6 - EDOCEXAM ( HFQ1070 )

3

English text: A LITTLE TROUBLE SEEING
LotOfTroubleSeeing

HFB2A - ECLEGBLI ( HFQ1065 )

4

English text: A LOT OF TROUBLE SEEING
NoUsableVision

HFB6 - EDOCEXAM ( HFQ1070 )

English text: NO USABLE VISION
Attribute

Route

Don't know

HFB6 - EDOCEXAM ( HFQ1070 )

Refusal

HFB6 - EDOCEXAM ( HFQ1070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:39 PM Thursday, March 28, 2013

Page 14 of 789

HFB2A

HFB2A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ECLEGBLI

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

90

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] been told that (you are/he is/she is) legally
blind?
[EXPLAIN IF NECESSARY: Informally, a person is legally blind
when, even with corrective lenses, they cannot see well enough to
drive.]

Int. Instr II:

INPUT FIELDS / ROUTING

4:12:40 PM Thursday, March 28, 2013

Page 15 of 789

HFB2A

Field1:

ECLEGBLI

Cheshire Name:

( HFQ1065 )

HEST.ECLEGBLI

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
HFB6 - EDOCEXAM ( HFQ1070 )

English text: YES
No

HFB6 - EDOCEXAM ( HFQ1070 )

English text: NO
Attribute

Route

Don't know

HFB6 - EDOCEXAM ( HFQ1070 )

Refusal

HFB6 - EDOCEXAM ( HFQ1070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:41 PM Thursday, March 28, 2013

Page 16 of 789

HFB6

HFB6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EDOCEXAM

Enable Functions:

HELP
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No
Yes
Yes

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Add Item
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No
No
No
No

Grid Functions:

Add Line
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No
No

110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[Have you/Has (SP)] had an eye examination by an eye doctor since
(LAST HF MONTH YEAR)?

Int. Instr II:

INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.

INPUT FIELDS / ROUTING

4:12:42 PM Thursday, March 28, 2013

Page 17 of 789

HFB6

Field1:

EDOCEXAM

Cheshire Name:

( HFQ1070 )

HEST.EDOCEXAM

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
HFB7A - EDOCTYPE ( HFQ1080 )

English text: YES
No

HFB7 - EDOCLAST ( HFQ1075 )

English text: NO
Attribute

Route

Don't know

BOX HFB1 - (HFQ1162 )

Refusal

BOX HFB1 - (HFQ1162 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:43 PM Thursday, March 28, 2013

Page 18 of 789

HFB7

HFB7

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

EDOCLAST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

130

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long has it been since [your/(SP's)] last eye examination by an
eye doctor?

Int. Instr II:
INPUT FIELDS / ROUTING

4:12:44 PM Thursday, March 28, 2013

Page 19 of 789

HFB7

Field1:

EDOCLAST

Cheshire Name:

( HFQ1075 )

HEST.EDOCLAST

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TEdoclst
1
No
No

Number Label
1 NeverHadEyeExam

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFB1 - (HFQ1162 )

2

English text: NEVER HAD EYE EXAM BY EYE DOCTOR
OneYearToLessThan2Years
HFB7A - EDOCTYPE ( HFQ1080 )

3

English text: 1 YEAR TO LESS THAN 2 YEARS
TwoYearsToLessThan5Years
HFB7A - EDOCTYPE ( HFQ1080 )

4

English text: 2 YEARS TO LESS THAN 5 YEARS
FiveYearsOrMore
HFB7A - EDOCTYPE ( HFQ1080 )
English text: 5 YEARS OR MORE

Attribute

Route

Don't know

BOX HFB1 - (HFQ1162 )

Refusal

BOX HFB1 - (HFQ1162 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:45 PM Thursday, March 28, 2013

Page 20 of 789

HFB7A

HFB7A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

EDOCTYPE

Field 2:

EDOCTYOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

142

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "(O.D.)" and "(M.D.)" in parentheses.

Multi Field display:

Vertical Alignment

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

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

I have a couple of questions about [your/(SP’s)] last eye examination.
Was the eye examination given by an optometrist, ophthalmologist
or some other type of doctor or eye care professional?
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry
(O.D.) who diagnoses and treats visual health problems. An
ophthalmologist is a doctor of medicine (M.D.) who specializes in
surgery and diseases of the eye.]

4:12:47 PM Thursday, March 28, 2013

Page 21 of 789

HFB7A
Int. Instr II:

INPUT FIELDS / ROUTING

EDOCTYPE

Field1:
Cheshire Name:

( HFQ1080 )

HEST.EDOCTYPE

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TEDocTyp
1
No
No

Number Label
1 Optometrist
2
91

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB7B - EDOCDLAT ( HFQ1090 )

English text: OPTOMETRIST
Ophthalmologist

HFB7B - EDOCDLAT ( HFQ1090 )

English text: OPHTHALMOLOGIST
OtherDocSpec

HFB7A - EDOCTYOS ( HFQ1085 )

English text: OTHER DOCTOR SPECIALTY
Attribute

Route

Don't know

BOX HFB1 - (HFQ1162 )

Refusal

BOX HFB1 - (HFQ1162 )

4:12:49 PM Thursday, March 28, 2013

Page 22 of 789

HFB7A

Field2:
Cheshire Name:

EDOCTYOS

( HFQ1085 )

HEST.EDOCTYOS

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
HFB7B - EDOCDLAT ( HFQ1090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:49 PM Thursday, March 28, 2013

Page 23 of 789

HFB7B

HFB7B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EDOCDLAT

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

145

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Again, thinking about [your/(SP’s)] last eye examination, were
dilating drops used in [your/(SP)’s] eyes?
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the
pupil for eye examinations. The drops often make your eyes more
sensitive to bright light and may cause temporary blurry vision.]

Int. Instr II:

INPUT FIELDS / ROUTING

4:12:50 PM Thursday, March 28, 2013

Page 24 of 789

HFB7B

Field1:

EDOCDLAT

Cheshire Name:

( HFQ1090 )

HEST.EDOCDLAT

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
HFB7C - ECATARAC ( HFQ1095 )

English text: YES
No

HFB7C - ECATARAC ( HFQ1095 )

English text: NO
Attribute

Route

Don't know

HFB7C - ECATARAC ( HFQ1095 )

Refusal

HFB7C - ECATARAC ( HFQ1095 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:51 PM Thursday, March 28, 2013

Page 25 of 789

HFB7C

HFB7C

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

ECATARAC

Field 2:

EGLAUCOM

Field 3:

ERETINOP

Field 4:

EMACULAR

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

148

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Vertical Alignment

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

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

I am going to read a list of eye conditions. Please tell me if [you
have/(SP) has] ever been told by a doctor that (you/he/she) had any
of these conditions.
[Have you/Has (SP)] ever been told by a doctor that (you/he/she)
had…

4:12:52 PM Thursday, March 28, 2013

Page 26 of 789

HFB7C
Int. Instr II:

INPUT FIELDS / ROUTING

ECATARAC

Field1:
Cheshire Name:

( HFQ1095 )

HEST.ECATARAC

Item Text display:

Display "a." in front of LIST item text.

Item Text:

Cataracts?

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
HFB7C - EGLAUCOM ( HFQ1102 )

English text: YES
No

HFB7C - EGLAUCOM ( HFQ1102 )

English text: NO
Attribute

Route

Don't know

HFB7C - EGLAUCOM ( HFQ1102 )

Refusal

HFB7C - EGLAUCOM ( HFQ1102 )

4:12:55 PM Thursday, March 28, 2013

Page 27 of 789

HFB7C

Field2:

EGLAUCOM

Cheshire Name:

( HFQ1102 )

HEST.EGLAUCOM

Item Text display:

Display "b." in front of LIST item text.

Item Text:

Glaucoma?

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
HFB7C - ERETINOP ( HFQ1107 )

English text: YES
No

HFB7C - ERETINOP ( HFQ1107 )

English text: NO
Attribute

Route

Don't know

HFB7C - ERETINOP ( HFQ1107 )

Refusal

HFB7C - ERETINOP ( HFQ1107 )

4:12:58 PM Thursday, March 28, 2013

Page 28 of 789

HFB7C

Field3:

ERETINOP

Cheshire Name:

( HFQ1107 )

HEST.ERETINOP

Item Text display:

Display "c." in front of LIST item text.

Item Text:

Diabetic retinopathy?

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
HFB7C - EMACULAR ( HFQ1112 )

English text: YES
No

HFB7C - EMACULAR ( HFQ1112 )

English text: NO
Attribute

Route

Don't know

HFB7C - EMACULAR ( HFQ1112 )

Refusal

HFB7C - EMACULAR ( HFQ1112 )

4:13:00 PM Thursday, March 28, 2013

Page 29 of 789

HFB7C

Field4:

EMACULAR

Cheshire Name:

( HFQ1112 )

HEST.EMACULAR

Item Text display:

Display "d." in front of LIST item text.

Item Text:

Macular degeneration or age-related macular degeneration,

also called AMD?

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
HFB10 - ECCATOP ( HFQ1157 )

English text: YES
No

HFB10 - ECCATOP ( HFQ1157 )

English text: NO
Attribute
Don't know

Route
HFB10 - ECCATOP ( HFQ1157 )

Refusal

HFB10 - ECCATOP ( HFQ1157 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:01 PM Thursday, March 28, 2013

Page 30 of 789

HFB10

HFB10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ECCATOP

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

151

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Have you/Has (SP)] ever had an operation for cataracts?

Int. Instr II:

INPUT FIELDS / ROUTING

4:13:02 PM Thursday, March 28, 2013

Page 31 of 789

HFB10

Field1:

ECCATOP

Cheshire Name:

( HFQ1157 )

HEST.ECCATOP

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFB1 - (HFQ1162 )

English text: YES
No

BOX HFB1 - (HFQ1162 )

English text: NO
Attribute

Route

Don't know

BOX HFB1 - (HFQ1162 )

Refusal

BOX HFB1 - (HFQ1162 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:03 PM Thursday, March 28, 2013

Page 32 of 789

BOX HFB1

BOX HFB1

Page Order # :

154

BOX INSTRUCTIONS
( HFQ1162 )

IF HFB7C - ERETINOP = 1/Yes OR HFB7C - EMACULAR = 1/Yes, GO TO
HFB11 - ELASRSUR ( HFQ1167 ).
ELSE GO TO HFC1 - HCHELP ( HFQ1180 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:13:03 PM Thursday, March 28, 2013

Page 33 of 789

HFB11

HFB11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ELASRSUR

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

157

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Laser surgery to the back of the eye, or retina, is a commonly used
treatment for diabetic retinopathy and macular degeneration.
Have [you/(SP)] ever had laser surgery to the back of either eye for
one of these conditions?
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to
the front of the eye used to correct vision.]

Int. Instr II:

4:13:04 PM Thursday, March 28, 2013

Page 34 of 789

HFB11
INPUT FIELDS / ROUTING
ELASRSUR

Field1:
Cheshire Name:

( HFQ1167 )

HEST.ELASRSUR

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFC1 - HCHELP ( HFQ1180 )

English text: YES
No

HFC1 - HCHELP ( HFQ1180 )

English text: NO
Attribute
Don't know

Route
HFC1 - HCHELP ( HFQ1180 )

Refusal

HFC1 - HCHELP ( HFQ1180 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:05 PM Thursday, March 28, 2013

Page 35 of 789

HFC1

HFC1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HCHELP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

177

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use a hearing aid?

Int. Instr II:

INPUT FIELDS / ROUTING

4:13:06 PM Thursday, March 28, 2013

Page 36 of 789

HFC1

Field1:

HCHELP

Cheshire Name:

( HFQ1180 )

HEST.HCHELP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THchelp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFC2 - HCTROUB ( HFQ1185 )

2

English text: YES
No

HFC2 - HCTROUB ( HFQ1185 )

3

English text: NO
Deaf

HFC3 - HCKNOWMC ( HFQ1190 )

English text: SP IS DEAF
Attribute
Don't know

Route
HFD1A - FOODTRBL ( HFQ1205 )

Refusal

HFD1A - FOODTRBL ( HFQ1205 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:07 PM Thursday, March 28, 2013

Page 37 of 789

HFC2

HFC2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HCTROUB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

180

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFC1 - HCHELP = 1/Yes, display "with a hearing aid".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Which statement best describes [your/(SP's)] hearing (with a hearing

aid): no trouble hearing, a little trouble, a lot of trouble, or deaf?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:08 PM Thursday, March 28, 2013

Page 38 of 789

HFC2

Field1:

HCTROUB

Cheshire Name:

( HFQ1185 )

HEST.HCTROUB

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THctrble
1
No
No

Number Label
1 NoTroubleHearing

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFD1A - FOODTRBL ( HFQ1205 )

2

English text: NO TROUBLE HEARING
ALittleTroubleHearing

3

English text: A LITTLE TROUBLE HEARING
ALotOfTroubleHearing
HFC3 - HCKNOWMC ( HFQ1190 )

4

English text: A LOT OF TROUBLE HEARING
Deaf
HFC3 - HCKNOWMC ( HFQ1190 )

HFC3 - HCKNOWMC ( HFQ1190 )

English text: DEAF
Attribute

Route

Don't know

HFD1A - FOODTRBL ( HFQ1205 )

Refusal

HFD1A - FOODTRBL ( HFQ1205 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:09 PM Thursday, March 28, 2013

Page 39 of 789

HFC3

HFC3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HCKNOWMC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

190

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFC1 - HCHELP = 3/SPIsDeaf or HFC2 - HCTROUB = 4/Deaf,
display "(you are/he is/she is) deaf".
Else display "of (your/his/her) difficulty hearing".

Multi Field display:

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

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

How much trouble [do you/does (SP)] have finding out things (you
need/he needs/she needs) to know about Medicare because [of
(your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would
you say (you have/she has/he has) no trouble, a little trouble, or a lot
of trouble?

Int. Instr II:

4:13:10 PM Thursday, March 28, 2013

Page 40 of 789

HFC3
INPUT FIELDS / ROUTING
HCKNOWMC

Field1:
Cheshire Name:

( HFQ1190 )

HEST.HCKNOWMC

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFC4 - HCCOMDOC ( HFQ1200 )

2

English text: NO TROUBLE
ALittleTrouble

HFC4 - HCCOMDOC ( HFQ1200 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFC4 - HCCOMDOC ( HFQ1200 )

English text: A LOT OF TROUBLE
Attribute

Route

Don't know

HFC4 - HCCOMDOC ( HFQ1200 )

Refusal

HFC4 - HCCOMDOC ( HFQ1200 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:11 PM Thursday, March 28, 2013

Page 41 of 789

HFC4

HFC4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HCCOMDOC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

200

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFC1 - HCHELP = 3/Deaf or HFC2 - HCTROUB = 4/Deaf, display
"(you are/he is/she is) deaf".
Else display "of (your/his/her) difficulty hearing".

Multi Field display:

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

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

How much trouble [do you/does (SP)] have communicating with
(your/his/her) doctor or other medical personnel because [of
(your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would
you say (you have/she has/he has) no trouble, a little trouble, or a lot
of trouble?

Int. Instr II:

4:13:12 PM Thursday, March 28, 2013

Page 42 of 789

HFC4
INPUT FIELDS / ROUTING
HCCOMDOC

Field1:
Cheshire Name:

( HFQ1200 )

HEST.HCCOMDOC

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFD1A - FOODTRBL ( HFQ1205 )

2

English text: NO TROUBLE
ALittleTrouble

HFD1A - FOODTRBL ( HFQ1205 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFD1A - FOODTRBL ( HFQ1205 )

English text: A LOT OF TROUBLE
Attribute

Route

Don't know

HFD1A - FOODTRBL ( HFQ1205 )

Refusal

HFD1A - FOODTRBL ( HFQ1205 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:14 PM Thursday, March 28, 2013

Page 43 of 789

HFD1A

HFD1A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

FOODTRBL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

220

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How much trouble [do you/does (SP)] have eating solid foods
because of problems with (your/his/her) mouth or teeth? Would you
say (you have/she has/he has) no trouble, a little trouble, or a lot of
trouble?

Int. Instr II:

INPUT FIELDS / ROUTING

4:13:15 PM Thursday, March 28, 2013

Page 44 of 789

HFD1A

Field1:

FOODTRBL

Cheshire Name:

( HFQ1205 )

HEST.FOODTRBL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFE1 - HEIGHTFT ( HFQ1230 )

2

English text: NO TROUBLE
ALittleTrouble

HFE1 - HEIGHTFT ( HFQ1230 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFE1 - HEIGHTFT ( HFQ1230 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFE1 - HEIGHTFT ( HFQ1230 )

Refusal

HFE1 - HEIGHTFT ( HFQ1230 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:16 PM Thursday, March 28, 2013

Page 45 of 789

HFE1

HFE1

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HEIGHTFT

Field 2:

HEIGHTIN

Field 3:

WEIGHT

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Display HFE1 - HEIGHTFT and HFE1 - HEIGHTIN input fields on 1st

line.

Display HFE1 - W EIGHT input field on 2nd line.

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:17 PM Thursday, March 28, 2013

Page 46 of 789

HFE1

Field1:

HEIGHTFT

Cheshire Name:

( HFQ1230 )

HEST.HEIGHTFT

Item Text display:
Item Text:

How tall [are you/is (SP)]?

Label:
Label Position:

FEET:
Left

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

Integer
THeightft
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFE1 - HEIGHTIN ( HFQ1240 )

Refusal

HFE1 - HEIGHTIN ( HFQ1240 )

4:13:20 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

3
7

Route
HFE1 - HEIGHTIN ( HFQ1240 )

Page 47 of 789

HFE1

Field2:

HEIGHTIN

Cheshire Name:

( HFQ1240 )

HEST.HEIGHTIN

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

INCHES:
Left

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

Integer
THeightin
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFE1 - WEIGHT ( HFQ1250 )

Refusal

HFE1 - WEIGHT ( HFQ1250 )

4:13:23 PM Thursday, March 28, 2013

FieldSize:

Min Value:
Max Value:
Mask:

0

11

Route
HFE1 - WEIGHT ( HFQ1250 )

Page 48 of 789

HFE1

Field3:

WEIGHT

Cheshire Name:

( HFQ1250 )

HEST.WEIGHT

Item Text display:
Item Text:

How much [do you/does (SP)] weigh?

Label:
Label Position:

WEIGHT:
Left

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

Integer
TWeights
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
999

Route
HFFINTRO - PREVHLTHINTRO ( HFQ1260 )

Attribute

Route

Don't know

HFFINTRO - PREVHLTHINTRO ( HFQ1260 )

Refusal

HFFINTRO - PREVHLTHINTRO ( HFQ1260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

Calculate Height based on HFE1 - HEIGHTFT and HFE1 ­
HEIGHTIN in inches.

HFE1 - HEIGHTFT and HFE1 - HEIGHTIN calculated height in

inches = 60 - 76.

If not true, display message "THE HEIGHT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

Edit #2:

HFE1 - W EIGHT = 80 - 280.

If not true, display message "THE WEIGHT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:13:24 PM Thursday, March 28, 2013

Page 49 of 789

HFE1

4:13:24 PM Thursday, March 28, 2013

Page 50 of 789

HFFINTRO

HFFINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PREVHLTHINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

250

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

These next few questions are about preventive health care
measures some people take.

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:25 PM Thursday, March 28, 2013

Page 51 of 789

HFFINTRO

Field1:

PREVHLTHINTRO

Cheshire Name:

( HFQ1260 )

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
HFF1 - BPTAKEN ( HFQ1270 )

English text: CONTINUE
Attribute

Route

Empty

HFF1 - BPTAKEN ( HFQ1270 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:26 PM Thursday, March 28, 2013

Page 52 of 789

HFF1

HFF1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

BPTAKEN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

260

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

When was the most recent time [you/(SP)] had (your/his/her) blood
pressure taken by a doctor or other health professional?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:27 PM Thursday, March 28, 2013

Page 53 of 789

HFF1

Field1:

BPTAKEN

Cheshire Name:

( HFQ1270 )

HEST.BPTAKEN

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TBptake
1
No
No

Number Label
1 LessThanSixMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF2 - BCTAKEN ( HFQ1280 )

2

English text: LESS THAN 6 MONTHS AGO
SixMonthsToOneYear

3

English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
HFF2 - BCTAKEN ( HFQ1280 )

4

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanFiveYears
HFF2 - BCTAKEN ( HFQ1280 )

5

English text: 2 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFF2 - BCTAKEN ( HFQ1280 )

6

English text: 5 OR MORE YEARS AGO
Never

HFF2 - BCTAKEN ( HFQ1280 )

HFF2 - BCTAKEN ( HFQ1280 )

English text: NEVER HAD BLOOD PRESSURE TAKEN
Attribute
Don't know

Route
HFF2 - BCTAKEN ( HFQ1280 )

Refusal

HFF2 - BCTAKEN ( HFQ1280 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:13:29 PM Thursday, March 28, 2013

Page 54 of 789

HFF1
TECHNICAL NOTES

DESIGN NOTES

4:13:29 PM Thursday, March 28, 2013

Page 55 of 789

HFF2

HFF2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

BCTAKEN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

270

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

When was the most recent time [you/(SP)] had (your/his/her) blood
cholesterol checked?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:30 PM Thursday, March 28, 2013

Page 56 of 789

HFF2

Field1:

BCTAKEN

Cheshire Name:

( HFQ1280 )

HEST.BCTAKEN

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TBcTake
1
No
No

Number Label
1 LessThanSixMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF1 - (HFQ1290 )

2

English text: LESS THAN 6 MONTHS AGO
SixMonthsToLessThanOneYear

3

English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
BOX HFF1 - (HFQ1290 )

4

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanFiveYears
BOX HFF1 - (HFQ1290 )

5

English text: 2 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
BOX HFF1 - (HFQ1290 )

6

English text: 5 OR MORE YEARS AGO
Never

BOX HFF1 - (HFQ1290 )

BOX HFF1 - (HFQ1290 )

English text: NEVER HAD CHOLESTEROL CHECKED
Attribute
Don't know

Route
BOX HFF1 - (HFQ1290 )

Refusal

BOX HFF1 - (HFQ1290 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:13:32 PM Thursday, March 28, 2013

Page 57 of 789

HFF2
TECHNICAL NOTES

DESIGN NOTES

4:13:32 PM Thursday, March 28, 2013

Page 58 of 789

BOX HFF1

BOX HFF1

Page Order # :

280

BOX INSTRUCTIONS
( HFQ1290 )

IF SP IS FEMALE, GO TO HFF3 - MAMMOGRM ( HFQ1300 ).
ELSE GO TO BOX HFF3 - (HFQ1440 ).

ASSIGNMENTS

TECHNICAL NOTES
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:13:32 PM Thursday, March 28, 2013

Page 59 of 789

HFF3

HFF3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MAMMOGRM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

290

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is not in the Supplemental Sample, display "These next few
questions are about. . .".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

(These next few questions are about preventive health care
measures some people take). [Have you/Has (SP)] had a
mammogram or a breast X-ray since (LAST HF MONTH YEAR)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:33 PM Thursday, March 28, 2013

Page 60 of 789

HFF3

Field1:

MAMMOGRM

Cheshire Name:

( HFQ1300 )

HEST.MAMMOGRM

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF6 - PAPSMEAR ( HFQ1360 )

English text: YES
No

BOX HFF1A - (HFQ1315 )

English text: NO
Attribute

Route

Don't know

HFF6 - PAPSMEAR ( HFQ1360 )

Refusal

HFF6 - PAPSMEAR ( HFQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:13:34 PM Thursday, March 28, 2013

Page 61 of 789

BOX HFF1A

BOX HFF1A

Page Order # :

310

BOX INSTRUCTIONS
( HFQ1315 )

IF THIS IS ROUND 67 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO HFF6 - PAPSMEAR ( HFQ1360 ).
ELSE GO TO HFF5 - MAMCODE ( HFQ1330 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:13:34 PM Thursday, March 28, 2013

Page 62 of 789

HFF5

HFF5

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

MAMCODE

Field 2:

MAMNOTHS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

320

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

What is the reason that [you have/(SP) has] not had a mammogram
since (LAST HF MONTH YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:13:36 PM Thursday, March 28, 2013

Page 63 of 789

HFF5

4:13:39 PM Thursday, March 28, 2013

Page 64 of 789

HFF5

Field1:

MAMCODE

Cheshire Name:

( HFQ1330 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.MAMNNEED
2=HEST.MAMNANUL
3=HEST.MAMNGET
4=HEST.MAMNRISK
5=HEST.MAMNPRES
6=HEST.MAMNREC
7=HEST.MAMNLIKE
8=HEST.MAMNLOCA
9=HEST.MAMNMISS
10=HEST.MAMNCOST
11=HEST.MAMNFEAR
12=HEST.MAMNRADI
13=HEST.MAMNHEAR
14=HEST.MAMNAPPT
15= HEST.MAMNMASC
16=HEST.MAMNILL
91=HEST.MAMNOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
THFF5CATA
17
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF6 - PAPSMEAR ( HFQ1360 )

2

English text: DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING WRONG
NotRecommendedEveryYear
HFF6 - PAPSMEAR ( HFQ1360 )

3

English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
HFF6 - PAPSMEAR ( HFQ1360 )

4

English text: DIDN’T THINK IT WOULD PREVENT BREAST CANCER/COULD GET BREAST
CANCER ANYWAY/TEST IS USELESS
NotAtRisk
HFF6 - PAPSMEAR ( HFQ1360 )

5

English text: NOT AT RISK FOR BREAST CANCER
DrNotRecommended
HFF6 - PAPSMEAR ( HFQ1360 )
English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT

4:13:42 PM Thursday, March 28, 2013

Page 65 of 789

HFF5

6

DrRecommendedAgainstIt

HFF6 - PAPSMEAR ( HFQ1360 )

7

English text: DOCTOR RECOMMENDED AGAINST GETTING IT
DontLikeMammogram
HFF6 - PAPSMEAR ( HFQ1360 )

8

English text: DON’T LIKE MAMMOGRAMS/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
HFF6 - PAPSMEAR ( HFQ1360 )

9

English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
HFF6 - PAPSMEAR ( HFQ1360 )

10

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfMammogram
HFF6 - PAPSMEAR ( HFQ1360 )

11

English text: COST OF MAMMOGRAM/INSURANCE DOESN’T COVER COST/NOT WORTH
THE MONEY
AfraidOfResults
HFF6 - PAPSMEAR ( HFQ1360 )

12

English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
CouldCauseCancer
HFF6 - PAPSMEAR ( HFQ1360 )

13

English text: MAMMOGRAM RADIATION COULD CAUSE CANCER/ILL EFFECTS
NeverHeardOfMammogram
HFF6 - PAPSMEAR ( HFQ1360 )

14

English text: NEVER HEARD OF MAMMOGRAM
AppointmentScheduled
HFF6 - PAPSMEAR ( HFQ1360 )

15

English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
Mastectomy
HFF6 - PAPSMEAR ( HFQ1360 )

16

English text: MASTECTOMY/BREASTS REMOVED
TooIll
HFF6 - PAPSMEAR ( HFQ1360 )

91

English text: TOO ILL, PHYSICALLY/MENTALLY
Other
HFF5 - MAMNOTHS ( HFQ1350 )
English text: OTHER

Attribute

Route

Don't know

HFF6 - PAPSMEAR ( HFQ1360 )

Refusal

HFF6 - PAPSMEAR ( HFQ1360 )

4:13:46 PM Thursday, March 28, 2013

Page 66 of 789

HFF5

Field2:
Cheshire Name:

MAMNOTHS

( HFQ1350 )

HEST.MAMNOTHS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
HFF6 - PAPSMEAR ( HFQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:46 PM Thursday, March 28, 2013

Page 67 of 789

HFF6

HFF6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PAPSMEAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

330

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[Have you/Has (SP)] had a Pap smear test since (LAST HF MONTH
YEAR)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:47 PM Thursday, March 28, 2013

Page 68 of 789

HFF6

Field1:

PAPSMEAR

Cheshire Name:

( HFQ1360 )

HEST.PAPSMEAR

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF2 - (HFQ1420 )

English text: YES
No

BOX HFF1B - (HFQ1375 )

English text: NO
Attribute

Route

Don't know

BOX HFF2 - (HFQ1420 )

Refusal

BOX HFF2 - (HFQ1420 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:48 PM Thursday, March 28, 2013

Page 69 of 789

BOX HFF1B

BOX HFF1B

Page Order # :

340

BOX INSTRUCTIONS
( HFQ1375 )

IF THIS IS ROUND 67 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFF2 - (HFQ1420 ).
ELSE GO TO HFF8 - PAPCODE ( HFQ1390 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:13:48 PM Thursday, March 28, 2013

Page 70 of 789

HFF8

HFF8

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PAPCODE

Field 2:

PAPNOTHS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

360

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

What is the reason that [you have/(SP) has] not had a Pap smear
test since (LAST HF MONTH YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:13:50 PM Thursday, March 28, 2013

Page 71 of 789

HFF8

4:13:53 PM Thursday, March 28, 2013

Page 72 of 789

HFF8

Field1:

PAPCODE

Cheshire Name:

( HFQ1390 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PAPNNEED
2=HEST.PAPNANUL
3= HEST.PAPNGET
4=HEST.PAPNRISK
5=HEST.PAPNPRES
6= HEST.PAPNREC
7= HEST.PAPNLIKE
8=HEST.PAPNLOCA
9=HEST.PAPNMISS
10= HEST.PAPNCOST
11=HEST.PAPNFEAR
12=HEST.PAPNHEAR
13=HEST.PAPNAPPT
14=HEST.PAPNHYST
15= HEST.PAPNILL
91=HEST.PAPNOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
THFF8CATA
16
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF2 - (HFQ1420 )

2

English text: DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING WRONG
NotRecommended
BOX HFF2 - (HFQ1420 )

3

English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
BOX HFF2 - (HFQ1420 )

4

English text: DIDN’T THINK IT WOULD PREVENT CANCER/COULD GET CANCER
ANYWAY/TEST IS USELESS
NotAtRisk
BOX HFF2 - (HFQ1420 )

5

English text: NOT AT RISK FOR CANCER
DrNotRecommended

BOX HFF2 - (HFQ1420 )

English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT

4:13:56 PM Thursday, March 28, 2013

Page 73 of 789

HFF8

6

DrRecommendAgainstIt

BOX HFF2 - (HFQ1420 )

7

English text: DOCTOR RECOMMENDED AGAINST GETTING IT
DontLikePapSmear
BOX HFF2 - (HFQ1420 )

8

English text: DON’T LIKE PAP SMEAR/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
BOX HFF2 - (HFQ1420 )

9

English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
BOX HFF2 - (HFQ1420 )

10

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfPapSmear
BOX HFF2 - (HFQ1420 )

11

English text: COST OF PAP SMEAR/INSURANCE DOESN’T COVER COST/NOT WORTH THE
MONEY
AfraidOfResults
BOX HFF2 - (HFQ1420 )

12

English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
NeverHeardOfPapSmear
BOX HFF2 - (HFQ1420 )

13

English text: NEVER HEARD OF PAP SMEAR
AppointmentScheduled
BOX HFF2 - (HFQ1420 )

14

English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
HadHysterectomy
BOX HFF2 - (HFQ1420 )

15

English text: HAD HYSTERECTOMY/NO UTERUS, OVARIES
TooIll
BOX HFF2 - (HFQ1420 )

91

English text: TOO ILL, PHYSICALLY/MENTALLY
Other
HFF8 - PAPNOTHS ( HFQ1410 )
English text: OTHER

Attribute

Route

Don't know

BOX HFF2 - (HFQ1420 )

Refusal

BOX HFF2 - (HFQ1420 )

4:13:59 PM Thursday, March 28, 2013

Page 74 of 789

HFF8

Field2:
Cheshire Name:

PAPNOTHS

( HFQ1410 )

HEST.PAPNOTHS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFF2 - (HFQ1420 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:59 PM Thursday, March 28, 2013

Page 75 of 789

BOX HFF2

BOX HFF2

Page Order # :

370

BOX INSTRUCTIONS
( HFQ1420 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND RESPONSE TO HHF8 –
PAPCODE DOES NOT INCLUDE 14/HadHysterectomy, GO TO HFF9 HYSTEREC ( HFQ1430 ).
ELSE GO TO HFF15 - FLUSHOT ( HFQ1540 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:13:59 PM Thursday, March 28, 2013

Page 76 of 789

HFF9

HFF9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYSTEREC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

380

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Have you/Has (SP)] ever had a hysterectomy?

Int. Instr II:

INPUT FIELDS / ROUTING

4:14:00 PM Thursday, March 28, 2013

Page 77 of 789

HFF9

Field1:

HYSTEREC

Cheshire Name:

( HFQ1430 )

HEST.HYSTEREC

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF15 - FLUSHOT ( HFQ1540 )

English text: YES
No

HFF15 - FLUSHOT ( HFQ1540 )

English text: NO
Attribute

Route

Don't know

HFF15 - FLUSHOT ( HFQ1540 )

Refusal

HFF15 - FLUSHOT ( HFQ1540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:01 PM Thursday, March 28, 2013

Page 78 of 789

BOX HFF3

BOX HFF3

Page Order # :

390

BOX INSTRUCTIONS
( HFQ1440 )

IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A
PREVIOUS ROUND, GO TO HFF11 - DIGTEXAM ( HFQ1460 ).
ELSE GO TO HFF10 - PROSSURG ( HFQ1450 ).

ASSIGNMENTS

TECHNICAL NOTES
385

HFProstateSurg

SP has ever reported having prostate surgery in a
previous round =
There is a HEST where HEST.HESTRND < current round
and (HEST.PROSSURG = 1/Yes or HEST.PROSRMVD
= 1/Yes).

DESIGN NOTES

4:14:02 PM Thursday, March 28, 2013

Page 79 of 789

HFF10

HFF10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PROSSURG

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

400

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "[Have you/Has (SP)] ever".
Else display "Since (LAST HF MONTH YEAR), [have you/has (SP)]".
If SP is the respondent, display "your".
Else display "his".

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[Since (LAST HF MONTH YEAR), [have you/has (SP)/[Have you/has
(SP)] ever] had surgery on (your/his) prostate?
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is
typically used as a treatment for prostate cancer or to correct urinary
problems. Surgery can include complete or partial removal of the

4:14:02 PM Thursday, March 28, 2013

Page 80 of 789

HFF10
prostate.]
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

PROSSURG

Cheshire Name:

( HFQ1450 )

HEST.PROSSURG

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF11 - DIGTEXAM ( HFQ1460 )

English text: YES
No

HFF11 - DIGTEXAM ( HFQ1460 )

English text: NO
Attribute

Route

Don't know

HFF11 - DIGTEXAM ( HFQ1460 )

Refusal

HFF11 - DIGTEXAM ( HFQ1460 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:14:04 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 81 of 789

HFF10
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:14:04 PM Thursday, March 28, 2013

Page 82 of 789

HFF11

HFF11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIGTEXAM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

410

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has ever reported having prostate surgery in the current round
or in a previous round, display "follow-up care sometimes
prescribed after prostate surgery."
Else display "preventive health care measures some people take."
If SP has not reported having prostate surgery in the current round
or any previous round, display "of the prostate".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

4:14:05 PM Thursday, March 28, 2013

These next few questions are about (preventive health care
measures some people take/follow-up care sometimes prescribed
after prostate surgery).

Page 83 of 789

HFF11
[Have you/Has (SP)] had a digital rectal examination (of the prostate)
since (LAST HF MONTH YEAR)?
[EXPLAIN IF NECESSARY: The exam may be used to detect
prostate cancer, to determine whether cancer has spread beyond
the prostate, and as part of follow-up care after prostate surgery.]
Int. Instr II:
INPUT FIELDS / ROUTING
DIGTEXAM

Field1:
Cheshire Name:

( HFQ1460 )

HEST.DIGTEXAM

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF12 - BLOODTST ( HFQ1470 )

English text: YES
No

HFF12 - BLOODTST ( HFQ1470 )

English text: NO
Attribute
Don't know

Route
HFF12 - BLOODTST ( HFQ1470 )

Refusal

HFF12 - BLOODTST ( HFQ1470 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:14:06 PM Thursday, March 28, 2013

Page 84 of 789

HFF11
TECHNICAL NOTES
387

HFProstateSurgCurrOr
Prev

If SP has ever reported having prostate surgery in the
current round or in a previous round =
(HEST.PROSSURG = /1Yes or HEST.PROSRMVD =
1/Yes ) on HEST where (HEST.HESTRND <= current
round).

DESIGN NOTES

4:14:06 PM Thursday, March 28, 2013

Page 85 of 789

HFF12

HFF12

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

BLOODTST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

420

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "PSA = PROSTATE-SPECIFIC ANTIGEN" in the same blue
font used for interviewer instructions.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[Have you/Has (SP)] had a blood test for detection of prostate
cancer, known as a PSA, since (LAST HF MONTH YEAR)?
PSA = PROSTATE-SPECIFIC ANTIGEN
[EXPLAIN IF NECESSARY: The test may be used to detect prostate
cancer, to determine whether cancer has spread beyond the
prostate, and as part of follow-up care after prostate surgery.]

Int. Instr II:
4:14:07 PM Thursday, March 28, 2013

Page 86 of 789

HFF12
INPUT FIELDS / ROUTING
BLOODTST

Field1:
Cheshire Name:

( HFQ1470 )

HEST.BLOODTST

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF15 - FLUSHOT ( HFQ1540 )

English text: YES
No

BOX HFF3B - (HFQ1485 )

English text: NO
Attribute
Don't know

Route
HFF15 - FLUSHOT ( HFQ1540 )

Refusal

HFF15 - FLUSHOT ( HFQ1540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:08 PM Thursday, March 28, 2013

Page 87 of 789

BOX HFF3B

BOX HFF3B

Page Order # :

430

BOX INSTRUCTIONS
( HFQ1485 )

IF THIS IS ROUND 67 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO HFF15 - FLUSHOT ( HFQ1540 ).
ELSE GO TO HFF14 - PRONCODE ( HFQ1500 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:14:08 PM Thursday, March 28, 2013

Page 88 of 789

HFF14

HFF14

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PRONCODE

Field 2:

PRONOTHS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

450

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

What is the reason that [you have/(SP) has] not had a prostate blood
test or PSA since (LAST HF MONTH YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:14:10 PM Thursday, March 28, 2013

Page 89 of 789

HFF14

4:14:13 PM Thursday, March 28, 2013

Page 90 of 789

HFF14

Field1:

PRONCODE

Cheshire Name:

( HFQ1500 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PRONNEED
2=HEST.PRONANUL
3=HEST.PRONGET
4=HEST.PRONRISK
5=HEST.PRONPRES
6=HEST.PRONREC
7=HEST.PRONLIKE
8=HEST.PRONLOCA
9=HEST.PRONMISS
10=HEST.PRONCOST
11=HEST.PRONFEAR
12=HEST.PRONHEAR
13=HEST.PRONAPPT
14=HEST.PRONPROS
91=HEST.PRONOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
THFF14CATA
15
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF15 - FLUSHOT ( HFQ1540 )

2

English text: DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING WRONG
NotRecommendedEveryYear
HFF15 - FLUSHOT ( HFQ1540 )

3

English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
HFF15 - FLUSHOT ( HFQ1540 )

4

English text: DIDN’T THINK IT WOULD PREVENT CANCER/COULD GET CANCER
ANYWAY/TEST IS USELESS
NotAtRisk
HFF15 - FLUSHOT ( HFQ1540 )

5

English text: NOT AT RISK FOR CANCER
DrNotRecommended

6

English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
DrRecommendedAgainstIt
HFF15 - FLUSHOT ( HFQ1540 )

HFF15 - FLUSHOT ( HFQ1540 )

English text: DOCTOR RECOMMENDED AGAINST GETTING IT
4:14:16 PM Thursday, March 28, 2013

Page 91 of 789

HFF14

7

DontLikeBloodTests

HFF15 - FLUSHOT ( HFQ1540 )

8

English text: DON’T LIKE BLOOD TESTS/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
HFF15 - FLUSHOT ( HFQ1540 )

9

English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
HFF15 - FLUSHOT ( HFQ1540 )

10

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfTest
HFF15 - FLUSHOT ( HFQ1540 )

11

English text: COST OF TEST/INSURANCE DOESN’T COVER COST/NOT WORTH THE MONEY
AfraidOfResults
HFF15 - FLUSHOT ( HFQ1540 )

12

English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
NeverHeardOfPsa
HFF15 - FLUSHOT ( HFQ1540 )

13

English text: NEVER HEARD OF PSA
AppointmentScheduled

14

English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
Prostatectomy
HFF15 - FLUSHOT ( HFQ1540 )

91

English text: PROSTATECTOMY/PROSTATE REMOVED
Other
HFF14 - PRONOTHS ( HFQ1520 )

HFF15 - FLUSHOT ( HFQ1540 )

English text: OTHER
Attribute

Route

Don't know

HFF15 - FLUSHOT ( HFQ1540 )

Refusal

HFF15 - FLUSHOT ( HFQ1540 )

4:14:19 PM Thursday, March 28, 2013

Page 92 of 789

HFF14

Field2:
Cheshire Name:

PRONOTHS

( HFQ1520 )

HEST.PRONOTHS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
HFF15 - FLUSHOT ( HFQ1540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:19 PM Thursday, March 28, 2013

Page 93 of 789

HFF15

HFF15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FLUSHOT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

470

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

PREVIOUS YEAR: (PREVIOUS YEAR)

Int. Instr I:
Question Text:

Did [you/(SP)] have a seasonal flu shot for last winter?
[EXPLAIN IF NECESSARY: Did [you/(SP)] have a seasonal flu shot
any time during the period from September (PREVIOUS YEAR)
through December (PREVIOUS YEAR)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:14:20 PM Thursday, March 28, 2013

Page 94 of 789

HFF15

Field1:

FLUSHOT

Cheshire Name:

( HFQ1540 )

HEST.FLUSHOT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF18 - FLUSITE ( HFQ1600 )

English text: YES
No

HFF17 - FLUCODE ( HFQ1560 )

English text: NO
Attribute

Route

Don't know

BOX HFF5 - (HFQ1657 )

Refusal

BOX HFF5 - (HFQ1657 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:21 PM Thursday, March 28, 2013

Page 95 of 789

HFF17

HFF17

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

FLUCODE

Field 2:

FLUOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

490

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Why didn't [you/(SP)] get a seasonal flu shot last winter?

[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:14:22 PM Thursday, March 28, 2013

Page 96 of 789

HFF17

4:14:25 PM Thursday, March 28, 2013

Page 97 of 789

HFF17

Field1:

FLUCODE

Cheshire Name:

( HFQ1560 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.FLUNEED
2=HEST.FLUCAUSE
3=HEST.FLUSIDE
4=HEST.FLUPRVNT
5=HEST.FLURISK
6=HEST.FLUDOCNO
7=HEST.FLUAGNST
8=HEST.FLUREACT
9=HEST.FLULOCAT
10=HEST.FLUMISS
11=HEST.FLUCOST
12=HEST.FLUBEFOR
13=HEST.FLUVACC
91=HEST.FLUOTHER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
THFF17CATA
14
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF4 - (HFQ1590 )

2

English text: DIDN’T KNOW IT WAS NEEDED
ShotCauseFlu
BOX HFF4 - (HFQ1590 )

3

English text: SHOT COULD CAUSE FLU
SideEffects

4

English text: SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
DidNotThinkPreventFlu
BOX HFF4 - (HFQ1590 )

5

English text: DIDN’T THINK IT WOULD PREVENT THE FLU/COULD GET THE FLU
ANYWAY
FluNotSerious
BOX HFF4 - (HFQ1590 )

6

English text: FLU NOT SERIOUS/WOULD NOT GET FLU ANYWAY/NOT AT RISK
DrNotRecommended
BOX HFF4 - (HFQ1590 )

BOX HFF4 - (HFQ1590 )

English text: DOCTOR DID NOT RECOMMEND THE SHOT

4:14:27 PM Thursday, March 28, 2013

Page 98 of 789

HFF17

7

AllergicToShot

BOX HFF4 - (HFQ1590 )

8

English text: DOCTOR RECOMMENDED AGAINST GETTING SHOT/ALLERGIC TO
SHOT/MEDICAL REASONS
DontLikeShots
BOX HFF4 - (HFQ1590 )

9

English text: DON’T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS OR
RASH/LOCAL REACTIONS
Inconvenient
BOX HFF4 - (HFQ1590 )

10

English text: INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
Forgot
BOX HFF4 - (HFQ1590 )

11

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT
CostOfShot
BOX HFF4 - (HFQ1590 )

12

English text: COST OF SHOT/NOT WORTH THE MONEY
HadShotBefore
BOX HFF4 - (HFQ1590 )

13

English text: HAD SHOT BEFORE/DIDN’T NEED IT AGAIN
VaccineUnavailable
BOX HFF4 - (HFQ1590 )

91

English text: VACCINE UNAVAILABLE/VACCINE SHORTAGE
Other
HFF17 - FLUOTHOS ( HFQ1580 )
English text: OTHER

Attribute

Route

Don't know

BOX HFF4 - (HFQ1590 )

Refusal

BOX HFF4 - (HFQ1590 )

Field2:
Cheshire Name:

FLUOTHOS

( HFQ1580 )

HEST.FLUOTHOS

Item Text display:

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

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

4:14:30 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFF4 - (HFQ1590 )

Page 99 of 789

HFF17
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:30 PM Thursday, March 28, 2013

Page 100 of 789

BOX HFF4

BOX HFF4

Page Order # :

500

BOX INSTRUCTIONS
( HFQ1590 )

IF RESPONSE TO HFF17 – FLUCODE DOES NOT INCLUDE
13/VaccineUnavailable, GO TO HFF21 - NOVACINE ( HFQ1611 ).
ELSE GO TO BOX HFF5 - (HFQ1657 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:30 PM Thursday, March 28, 2013

Page 101 of 789

HFF18

HFF18

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

FLUSITE

Field 2:

FLUSITOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

510

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "IF CLINIC ASK:" and "IF SOME OTHER PLACE, ASK:" in
same blue font used for interviewer instructions.

Multi Field display:

Vertical Alignment

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

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

Where did [you/(SP)] go for (your/his/her) most recent seasonal flu
shot, was that a managed care plan or HMO center, a clinic, a
doctor’s office, a hospital, a health fair, shopping mall, or some other
place?
[IF CLINIC, ASK: Was it a hospital outpatient clinic, or some other
kind of clinic? IF SOME OTHER PLACE, ASK: Where was this?]

4:14:31 PM Thursday, March 28, 2013

Page 102 of 789

HFF18
Int. Instr II:

INPUT FIELDS / ROUTING

4:14:35 PM Thursday, March 28, 2013

Page 103 of 789

HFF18

Field1:

FLUSITE

Cheshire Name:
Item Text display:

( HFQ1600 )

HEST.FLUSITE
Do not display response options 28/HealthDepartment and
29/PlaceofWork. Display response options in the following
order: 1, 2, 3, 4, 5, 6, 7, 8 , 9, 10, 11, 19, 12, 13, 14, 15,
16, 17, 18.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TFlusite
1
No
No

Number Label
1 DrsOfficeOrGroupPractice

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF18A - VACPAID ( HFQ1605 )

2

English text: DOCTORS OFFICE OR GROUP PRACTICE
DoctorsClinic
HFF18A - VACPAID ( HFQ1605 )

3

English text: MEDICAL CLINIC
ManagedCarePlanCenter

4

English text: MANAGED CARE PLAN CENTER/HMO
NeighborhoodHealthCenter
HFF18A - VACPAID ( HFQ1605 )

5

English text: NEIGHBORHOOD/FAMILY HEALTH CENTER
FreestandingSurgicalCenter
HFF18A - VACPAID ( HFQ1605 )

6

English text: FREESTANDING SURGICAL CENTER
RuralHealthClinic
HFF18A - VACPAID ( HFQ1605 )

7

English text: RURAL HEALTH CLINIC
CompanyClinic

HFF18A - VACPAID ( HFQ1605 )

8

English text: COMPANY CLINIC
OtherClinic

HFF18A - VACPAID ( HFQ1605 )

9

English text: OTHER CLINIC
WalkInUrgentCenter

HFF18A - VACPAID ( HFQ1605 )

10

English text: WALK-IN URGENT CENTER
HospitalEmergencyRoom

HFF18A - VACPAID ( HFQ1605 )

11

English text: HOSPITAL EMERGENCY ROOM
HospitalOutpatientDept
HFF18A - VACPAID ( HFQ1605 )

12

English text: HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
VaFacility
HFF18A - VACPAID ( HFQ1605 )

HFF18A - VACPAID ( HFQ1605 )

English text: VA FACILITY
4:14:39 PM Thursday, March 28, 2013

Page 104 of 789

HFF18

13

HealthFair

HFF18A - VACPAID ( HFQ1605 )

14

English text: HEALTH FAIR
ShoppingMall

HFF18A - VACPAID ( HFQ1605 )

15

English text: SHOPPING MALL/OTHER STORE
SeniorCenter
HFF18A - VACPAID ( HFQ1605 )

16

English text: SENIOR CENTER
SpsHome

HFF18A - VACPAID ( HFQ1605 )

17

English text: AT HOME
Churchschool

HFF18A - VACPAID ( HFQ1605 )

18

English text: CHURCH/SCHOOL
Library1

HFF18A - VACPAID ( HFQ1605 )

19

English text: LIBRARY
HospitalInpatient

HFF18A - VACPAID ( HFQ1605 )

28

English text: HOSPITAL INPATIENT
HealthDepatment
DATA EDITING ONLY. DO NOT DISPLAY.

29

English text: HEALTH DEPARTMENT
PlaceOfWork

91

English text: PLACE OF WORK
Other

DATA EDITING ONLY. DO NOT DISPLAY.
HFF18 - FLUSITOS ( HFQ1602 )

English text: OTHER
Attribute
Don't know

Route
HFF18A - VACPAID ( HFQ1605 )

Refusal

HFF18A - VACPAID ( HFQ1605 )

4:14:42 PM Thursday, March 28, 2013

Page 105 of 789

HFF18

Field2:
Cheshire Name:

FLUSITOS

( HFQ1602 )

HEST.FLUSITOS

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
HFF18A - VACPAID ( HFQ1605 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:42 PM Thursday, March 28, 2013

Page 106 of 789

HFF18A

HFF18A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VACPAID

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

511

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Did [you/(SP)] pay some or all of the cost of the flu shot?
Please include any monetary donations that you may have made to
cover the cost of the flu shot.

Int. Instr II:

INPUT FIELDS / ROUTING

4:14:43 PM Thursday, March 28, 2013

Page 107 of 789

HFF18A

Field1:

VACPAID

Cheshire Name:

( HFQ1605 )

HEST.VACPAID

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
HFF20 - VACSUPLY ( HFQ1609 )

English text: YES
No

HFF20 - VACSUPLY ( HFQ1609 )

English text: NO
Attribute

Route

Don't know

HFF20 - VACSUPLY ( HFQ1609 )

Refusal

HFF20 - VACSUPLY ( HFQ1609 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:44 PM Thursday, March 28, 2013

Page 108 of 789

HFF20

HFF20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VACSUPLY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

513

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Did [you/(SP)] have any trouble getting a seasonal flu shot when
(you/he/she) wanted to because the vaccine was in short supply or
unavailable?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:45 PM Thursday, March 28, 2013

Page 109 of 789

HFF20

Field1:

VACSUPLY

Cheshire Name:

( HFQ1609 )

HEST.VACSUPLY

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF5 - (HFQ1657 )

English text: YES
No

BOX HFF5 - (HFQ1657 )

English text: NO
Attribute

Route

Don't know

BOX HFF5 - (HFQ1657 )

Refusal

BOX HFF5 - (HFQ1657 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:46 PM Thursday, March 28, 2013

Page 110 of 789

HFF21

HFF21

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

NOVACINE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

516

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Was one reason that [you/(SP)] did not get a seasonal flu shot last
winter because the vaccine was in short supply or unavailable?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:47 PM Thursday, March 28, 2013

Page 111 of 789

HFF21

Field1:

NOVACINE

Cheshire Name:

( HFQ1611 )

HEST.NOVACINE

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF5 - (HFQ1657 )

English text: YES
No

BOX HFF5 - (HFQ1657 )

English text: NO
Attribute

Route

Don't know

BOX HFF5 - (HFQ1657 )

Refusal

BOX HFF5 - (HFQ1657 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:48 PM Thursday, March 28, 2013

Page 112 of 789

BOX HFF5

BOX HFF5

550

Page Order # :

BOX INSTRUCTIONS
( HFQ1657 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFF22 - PNEUSHOT (
HFQ1660 ).
ELSE IF SP HAS EVER REPORTED HAVING A PNEUMONIA SHOT IN A
PREVIOUS ROUND, GO TO BOX HFG1 - (HFQ1710 ).
ELSE GO TO HFF22 - PNEUSHOT ( HFQ1660 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

388

HFPneumoniaShot

SP has ever reported having a pneumonia shot in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.PNEUSHOT = 1/Yes.

DESIGN NOTES

4:14:48 PM Thursday, March 28, 2013

Page 113 of 789

HFF22

HFF22

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PNEUSHOT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

560

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Have you/Has (SP)] ever had a shot for pneumonia?

Int. Instr II:

INPUT FIELDS / ROUTING

4:14:48 PM Thursday, March 28, 2013

Page 114 of 789

HFF22

Field1:

PNEUSHOT

Cheshire Name:

( HFQ1660 )

HEST.PNEUSHOT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFG1 - (HFQ1710 )

English text: YES
No

BOX HFF5B - (HFQ1665 )

English text: NO
Attribute

Route

Don't know

BOX HFG1 - (HFQ1710 )

Refusal

BOX HFG1 - (HFQ1710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:50 PM Thursday, March 28, 2013

Page 115 of 789

BOX HFF5B

BOX HFF5B

Page Order # :

565

BOX INSTRUCTIONS
( HFQ1665 )

IF THIS IS ROUND 67 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFG1 - (HFQ1710 ).
ELSE GO TO HFF23 - PNUCODE ( HFQ1680 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:14:50 PM Thursday, March 28, 2013

Page 116 of 789

HFF23

HFF23

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

PNUCODE

Field 2:

PNUOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

570

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Why didn't [you/(SP)] ever have a shot for pneumonia?

[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:14:51 PM Thursday, March 28, 2013

Page 117 of 789

HFF23

4:14:53 PM Thursday, March 28, 2013

Page 118 of 789

HFF23

Field1:

PNUCODE

Cheshire Name:

( HFQ1680 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PNUNEED
2=HEST.PNUCAUSE
3=HEST.PNUSIDE
4=HEST.PNUPRVNT
5=HEST.PNURISK
6=HEST.PNUDOCNO
7=HEST.PNUAGNST
8=HEST.PNUREACT
9=HEST.PNULOCAT
10=HEST.PNUMISS
11=HEST.PNUCOST
91=HEST.PNUOTHER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
THFF23CATA
12
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFG1 - (HFQ1710 )

2

English text: DIDN'T KNOW IT WAS NEEDED
CouldCausePneumonia
BOX HFG1 - (HFQ1710 )

3

English text: SHOT COULD CAUSE PNEUMONIA
SideEffects
BOX HFG1 - (HFQ1710 )

4

English text: SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
DidNotThinkPreventPneumonia
BOX HFG1 - (HFQ1710 )

5

English text: DIDN'T THINK IT WOULD PREVENT PNEUMONIA/COULD GET PNEUMONIA
ANYWAY
NotAtRisk
BOX HFG1 - (HFQ1710 )

6

English text: PNEUMONIA NOT SERIOUS/WOULD NOT GET PNEUMONIA ANYWAY/NOT
AT RISK
DrNotRecommended
BOX HFG1 - (HFQ1710 )
English text: DOCTOR DID NOT RECOMMEND THE SHOT

4:14:56 PM Thursday, March 28, 2013

Page 119 of 789

HFF23

7

AllergicToShot

BOX HFG1 - (HFQ1710 )

8

English text: DOCTOR RECOMMENDED AGAINST GETTING SHOT/ALLERGIC TO
SHOT/MEDICAL REASONS
DontLikeShots
BOX HFG1 - (HFQ1710 )

9

English text: DON'T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS OR
RASH/LOCAL REACTIONS
Inconvenient
BOX HFG1 - (HFQ1710 )

10

English text: INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
Forgot
BOX HFG1 - (HFQ1710 )

11

English text: DIDN'T THINK ABOUT IT/FORGOT/MISSED IT
CostOfShot
BOX HFG1 - (HFQ1710 )

91

English text: COST OF SHOT/NOT WORTH THE MONEY
Other
HFF23 - PNUOTHOS ( HFQ1700 )
English text: OTHER

Attribute

Route

Don't know

BOX HFG1 - (HFQ1710 )

Refusal

BOX HFG1 - (HFQ1710 )

Field2:
Cheshire Name:

PNUOTHOS

( HFQ1700 )

HEST.PNUOTHOS

Item Text display:

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

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

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

String
TOthrspec
1

No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFG1 - (HFQ1710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
4:14:58 PM Thursday, March 28, 2013

Page 120 of 789

HFF23

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:58 PM Thursday, March 28, 2013

Page 121 of 789

BOX HFG1

BOX HFG1

580

Page Order # :

BOX INSTRUCTIONS
( HFQ1710 )

IF SP WAS ASKED IF HE/SHE NOW SMOKES CIGARETTES, CIGARS, OR
PIPE TOBACCO IN A PREVIOUS ROUND, GO TO HFG2 - SMOKNOW (
HFQ1740 ).
ELSE GO TO HFG1 - EVERSMOK ( HFQ1720 ).

ASSIGNMENTS

TECHNICAL NOTES
419

HFNowSmokesPrev

SP was asked if he/she now smokes cigarettes, cigars,
or pipe tobacco in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.SMOKNOW ^= empty.

DESIGN NOTES

4:14:58 PM Thursday, March 28, 2013

Page 122 of 789

HFG1

HFG1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EVERSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

590

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] ever smoked cigarettes, cigars, or pipe
tobacco?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:59 PM Thursday, March 28, 2013

Page 123 of 789

HFG1

Field1:

EVERSMOK

Cheshire Name:

( HFQ1720 )

HEST.EVERSMOK

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG2 - SMOKNOW ( HFQ1740 )

English text: YES
No

BOX HFG1C - (HFQ1793 )

English text: NO
Attribute

Route

Don't know

BOX HFG1C - (HFQ1793 )

Refusal

BOX HFG1C - (HFQ1793 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:00 PM Thursday, March 28, 2013

Page 124 of 789

HFG2

HFG2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SMOKNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

600

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] smoke cigarettes, cigars, or pipe tobacco now?

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:00 PM Thursday, March 28, 2013

Page 125 of 789

HFG2

Field1:

SMOKNOW

Cheshire Name:
Item Text display:

( HFQ1740 )

HEST.SMOKNOW

Do not display response option 3/NoButOriginalllyYes.

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TOchbp

1
No

No

Number Label
1 Yes

FieldSize:

Min Value:

Max Value:

Mask:

Route
BOX HFG1A - (HFQ1745 )

2

English text: YES
No

3

English text: NO
NoButOriginallyYes

BOX HFG1A - (HFQ1745 )
BOX HFG1C - (HFQ1793 )

DO NOT DISPLAY.

DATA EDITING ONLY.

English text: NO, BUT ORIGINALLY YES
Attribute

Route

Don't know

BOX HFG1C - (HFQ1793 )

Refusal

BOX HFG1C - (HFQ1793 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:02 PM Thursday, March 28, 2013

Page 126 of 789

BOX HFG1A

BOX HFG1A

Page Order # :

620

BOX INSTRUCTIONS
( HFQ1745 )

IF THIS IS ROUND 67 THEN .
IF HFG2-SMOKNOW = 2/No, GO TO HFG3 - DIDSMOKE ( HFQ1755 ).
ELSE GO TO HFG5 - HAVSMOKE ( HFQ1775 ).
ELSE IF THIS IS NOT ROUND 67 THEN .
IF HFG2-SMOKNOW = 2/No, GO TO BOX HFG1C - (HFQ1793 ).
ELSE GO TO HFG5A - DRQTSMOK ( HFQ1784 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:02 PM Thursday, March 28, 2013

Page 127 of 789

HFG3

HFG3

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIDSMOKE

Field 2:

DIDSMOKE_LESSONE

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

640

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

How many years did [you/(SP)] smoke?

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:03 PM Thursday, March 28, 2013

Page 128 of 789

HFG3

Field1:

DIDSMOKE

Cheshire Name:

( HFQ1755 )

HEST.DIDSMOKE

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF YEARS:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TDidsmok
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

Attribute

Route

Empty

HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

Don't know

HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

Refusal

HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

4:15:05 PM Thursday, March 28, 2013

1

96

Page 129 of 789

HFG3
DIDSMOKE_LESSONE ( HFQ1758 )

Field2:

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.DIDSMOKE_LESSONE = 1/LessThanOneYear, set

HEST.DIDSMOKE = 96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TDidSmok96
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG4 - LASTSMOK ( HFQ1765 )

English text: LESS THAN ONE YEAR
Attribute
Empty

Route
HFG4 - LASTSMOK ( HFQ1765 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If DIDSMOKE ^= EMPTY then DIDSMOKE = 1-75, DK, RF.

If not true, display message "UNLIKELY NUMBER OF YEARS.

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If DIDSMOKE ^= EMPTY then DIDSMOKE = 1-95, DK, RF.

If not true, display message "NUMBER OF YEARS MUST BE

BETWEEN 1 AND 95 OR LESS THAN ONE YEAR. PLEASE

REENTER."

Edit #2

DIDSMOKE and DIDSMOKE_LESSONE cannot both be EMPTY.

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

4:15:07 PM Thursday, March 28, 2013

Page 130 of 789

HFG3
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
DIDSMOKE and DIDSMOKE_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES

DESIGN NOTES

4:15:07 PM Thursday, March 28, 2013

Page 131 of 789

HFG4

HFG4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LASTSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

650

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

About how long has it been since [you/(SP)] last smoked regularly?

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:08 PM Thursday, March 28, 2013

Page 132 of 789

HFG4

Field1:

LASTSMOK

Cheshire Name:

( HFQ1765 )

HEST.LASTSMOKE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TLastsmo
1
No
No

Number Label
1 WithTheLastMonth

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFG1C - (HFQ1793 )

2

English text: WITHIN THE LAST MONTH
OneMonthToLessThan6MonthsAgo

3

English text: 1 MONTH TO LESS THAN 6 MONTHS AGO
SixMonthsToLessThan1YearAgo
BOX HFG1C - (HFQ1793 )

4

English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThan5YearsAgo
BOX HFG1C - (HFQ1793 )

5

English text: 1 YEAR TO LESS THAN 5 YEARS AGO
FiveYearsToLessThan10YearsAgo
BOX HFG1C - (HFQ1793 )

6

English text: 5 YEARS TO LESS THAN 10 YEARS AGO
TenOrMoreYearsAgo
BOX HFG1C - (HFQ1793 )

BOX HFG1C - (HFQ1793 )

English text: 10 OR MORE YEARS AGO
Attribute
Don't know

Route
BOX HFG1C - (HFQ1793 )

Refusal

BOX HFG1C - (HFQ1793 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
4:15:09 PM Thursday, March 28, 2013

Page 133 of 789

HFG4

TECHNICAL NOTES

DESIGN NOTES

4:15:10 PM Thursday, March 28, 2013

Page 134 of 789

HFG5

HFG5

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HAVSMOKE

Field 2:

HAVSMOKE_LESSON

E

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

660

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

How many years [have you/has (SP)] smoked?

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:11 PM Thursday, March 28, 2013

Page 135 of 789

HFG5

Field1:

HAVSMOKE

Cheshire Name:

( HFQ1775 )

HEST.HAVSMOKE

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

NUMBER OF YEARS:
Left

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

Integer
TDidsmok
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

Attribute

Route

Empty

HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

Don't know

HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

Refusal

HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

4:15:13 PM Thursday, March 28, 2013

1

96

Page 136 of 789

HFG5
HAVSMOKE_LESSON ( HFQ1778 )
E

Field2:

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.HAVSMOKE_LESSONE = 1/LessThanOneYear, set

HEST.HAVSMOKE = 96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TDidSmok96
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG5A - DRQTSMOK ( HFQ1784 )

English text: LESS THAN ONE YEAR
Attribute
Empty

Route
HFG5A - DRQTSMOK ( HFQ1784 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If HAVSMOKE ^= EMPTY then HAVSMOKE = 1-75, DK, RF.

If not true, display message "UNLIKELY NUMBER OF YEARS.

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If HAVSMOKE ^= EMPTY then HAVSMOKE = 1-95, DK, RF.

If not true, display message "NUMBER OF YEARS MUST BE

BETWEEN 1 AND 95 OR LESS THAN ONE YEAR, PLEASE

REENTER."

Edit #2

HAVSMOKE and HAVSMOKE_LESSONE cannot both be EMPTY.

4:15:15 PM Thursday, March 28, 2013

Page 137 of 789

HFG5
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
HAVSMOKE and HAVSMOKE_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES

DESIGN NOTES

4:15:15 PM Thursday, March 28, 2013

Page 138 of 789

HFG5A

HFG5A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DRQTSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

670

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), has a doctor or other health
professional advised [you/(SP)] to quit smoking?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:15 PM Thursday, March 28, 2013

Page 139 of 789

HFG5A

Field1:

DRQTSMOK

Cheshire Name:

( HFQ1784 )

HEST.DRQTSMOK

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 HFG1B - (HFQ1787 )

English text: YES
No

BOX HFG1B - (HFQ1787 )

English text: NO
Attribute

Route

Don't know

BOX HFG1B - (HFQ1787 )

Refusal

BOX HFG1B - (HFQ1787 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:16 PM Thursday, March 28, 2013

Page 140 of 789

BOX HFG1B

BOX HFG1B

Page Order # :

672

BOX INSTRUCTIONS
( HFQ1787 )

IF THIS IS ROUND 67, GO TO HFG6 - QUITSMOK ( HFQ1789 ).
ELSE GO TO BOX HFG1C - (HFQ1793 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:16 PM Thursday, March 28, 2013

Page 141 of 789

HFG6

HFG6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

QUITSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

675

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

During the past 12 months, [have you/has (SP)] stopped smoking for
one day or longer because (you were/he was/she was) trying to quit
smoking?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:17 PM Thursday, March 28, 2013

Page 142 of 789

HFG6

Field1:

QUITSMOK

Cheshire Name:

( HFQ1789 )

HEST.QUITSMOK

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 HFG1C - (HFQ1793 )

English text: YES
No

BOX HFG1C - (HFQ1793 )

English text: NO
Attribute

Route

Don't know

BOX HFG1C - (HFQ1793 )

Refusal

BOX HFG1C - (HFQ1793 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:18 PM Thursday, March 28, 2013

Page 143 of 789

BOX HFG1C

BOX HFG1C

Page Order # :

680

BOX INSTRUCTIONS
( HFQ1793 )

IF THIS IS ROUND 67, GO TO HFG7 - DRINKDAY ( HFQ1795 ).
ELSE GO TO HFHINTRO - DIFINTRO ( HFQ1870 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:18 PM Thursday, March 28, 2013

Page 144 of 789

HFG7

HFG7

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DRINKDAY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

690

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

The next questions are about drinking alcoholic beverages. Included
are liquor such as whiskey or gin, mixed drinks, wine, beer, and any
other type of alcoholic beverage.
Please think about a typical month in the past year. On how many
days did [you/(SP)] drink any type of alcoholic beverage?

Int. Instr II:

ENTER "0" FOR "NEVER DRANK" OR "NONE".

INPUT FIELDS / ROUTING
4:15:19 PM Thursday, March 28, 2013

Page 145 of 789

HFG7

Field1:

DRINKDAY

Cheshire Name:

( HFQ1795 )

HEST.DRINKDAY

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

NUMBER OF DAYS:
Left

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

Integer
TDrinkda
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

BOX HFG2 - (HFQ1805 )

Refusal

BOX HFG2 - (HFQ1805 )

FieldSize:

Min Value:
Max Value:
Mask:

0

31

Route
BOX HFG2 - (HFQ1805 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:20 PM Thursday, March 28, 2013

Page 146 of 789

BOX HFG2

BOX HFG2

Page Order # :

700

BOX INSTRUCTIONS
( HFQ1805 )

IF HFG7 - DRINKDAY = 0, GO TO HFHINTRO - DIFINTRO ( HFQ1870 ).
ELSE GO TO HFG8 - DRINKSPD ( HFQ1815 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:20 PM Thursday, March 28, 2013

Page 147 of 789

HFG8

HFG8

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DRINKSPD

Field 2:

DRINKSPD_LESSONE

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

710

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[Please…]" in brackets.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Please think about a typical month in the past year.] On those days
that [you/(SP)] drank alcohol, how many drinks did (you/he/she)
have?

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:21 PM Thursday, March 28, 2013

Page 148 of 789

HFG8

Field1:

DRINKSPD

Cheshire Name:

( HFQ1815 )

HEST.DRINKSPD

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

NUMBER OF DRINKS:
Left

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

Integer
Tdrinksp
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

Attribute

Route

Empty

HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

Don't know

HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

Refusal

HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

4:15:24 PM Thursday, March 28, 2013

1

96

Page 149 of 789

HFG8
DRINKSPD_LESSONE ( HFQ1818 )

Field2:
Cheshire Name:

NONE
REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.DRINKSPD_LESSONE =

1/LessThanOneAlcoholDrinkPerDay, set HEST.DRINKSPD =

96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TDrinksp96
1
No
No

Number Label
1 LessThanOne

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG9 - FOURDRNK ( HFQ1825 )

English text: LESS THAN ONE
Attribute
Empty

Route
HFG9 - FOURDRNK ( HFQ1825 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If DRINKSPD ^= EMPTY then DRINKSPD = 1-12, DK, RF.

If not true, display message "UNLIKELY NUMBER OF DRINKS.

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If DRINKSPD ^= EMPTY then DRINKSPD = 1-50, DK, RF.

If not true, display message "NUMBER OF DRINKS MUST BE

BETWEEN 1 AND 50 OR LESS THAN ONE. PLEASE REENTER."

Edit #2

DRINKSPD and DRINKSPD_LESSONE cannot both be EMPTY.

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

4:15:25 PM Thursday, March 28, 2013

Page 150 of 789

HFG8
NUMBER OF DRINKS OR SELECT "LESS THAN ONE"."
Edit #3
DRINKSPD and DRINKSPD_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF DRINKS OR SELECT "LESS THAN ONE"."
TECHNICAL NOTES

DESIGN NOTES

4:15:25 PM Thursday, March 28, 2013

Page 151 of 789

HFG9

HFG9

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

FOURDRNK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

720

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[Please…]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Please think about a typical month in the past year.] On how many

days did [you/(SP)] have 4 or more drinks in a single day?

Int. Instr II:

ENTER "0" FOR "NEVER" OR "NONE".

INPUT FIELDS / ROUTING

4:15:26 PM Thursday, March 28, 2013

Page 152 of 789

HFG9

Field1:

FOURDRNK

Cheshire Name:

( HFQ1825 )

HEST.FOURDRNK

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

NUMBER OF DAYS:
Left

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

Integer
TDrinkda
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFHINTRO - DIFINTRO ( HFQ1870 )

Refusal

HFHINTRO - DIFINTRO ( HFQ1870 )

FieldSize:

Min Value:
Max Value:
Mask:

0

31

Route
HFHINTRO - DIFINTRO ( HFQ1870 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:27 PM Thursday, March 28, 2013

Page 153 of 789

HFHINTRO

HFHINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

DIFINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

730

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now, I'm going to ask about how difficult it is, on the average, for
[you/(SP)] to do certain kinds of activities. Please tell me for each
activity whether [you have/(SP) has] no difficulty at all, a little
difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it.

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:28 PM Thursday, March 28, 2013

Page 154 of 789

HFHINTRO

Field1:

DIFINTRO

Cheshire Name:

( HFQ1870 )

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
HFH1 - DIFSTOOP ( HFQ1880 )

English text: CONTINUE
Attribute

Route

Empty

HFH1 - DIFSTOOP ( HFQ1880 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:29 PM Thursday, March 28, 2013

Page 155 of 789

HFH1

HFH1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFSTOOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

740

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF1

Question Text:

How much difficulty, if any, [do you/does (SP)] have stooping,
crouching, or kneeling? Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:29 PM Thursday, March 28, 2013

Page 156 of 789

HFH1

Field1:

DIFSTOOP

( HFQ1880 )

HEST.DIFSTOOP

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH2 - DIFLIFT ( HFQ1890 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH2 - DIFLIFT ( HFQ1890 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH2 - DIFLIFT ( HFQ1890 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH2 - DIFLIFT ( HFQ1890 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH2 - DIFLIFT ( HFQ1890 )

English text: NOT ABLE TO DO IT
Attribute

Route

Don't know

HFH2 - DIFLIFT ( HFQ1890 )

Refusal

HFH2 - DIFLIFT ( HFQ1890 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:15:31 PM Thursday, March 28, 2013

Page 157 of 789

HFH1
DESIGN NOTES

4:15:31 PM Thursday, March 28, 2013

Page 158 of 789

HFH2

HFH2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFLIFT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

750

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF1

Question Text:

How much difficulty, if any, [do you/does (SP)] have lifting or carrying
objects as heavy as 10 pounds, like a sack of potatoes?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:32 PM Thursday, March 28, 2013

Page 159 of 789

HFH2

Field1:

DIFLIFT

( HFQ1890 )

HEST.DIFLIFT

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH3 - DIFREACH ( HFQ1900 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH3 - DIFREACH ( HFQ1900 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH3 - DIFREACH ( HFQ1900 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH3 - DIFREACH ( HFQ1900 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH3 - DIFREACH ( HFQ1900 )

English text: NOT ABLE TO DO IT
Attribute

Route

Don't know

HFH3 - DIFREACH ( HFQ1900 )

Refusal

HFH3 - DIFREACH ( HFQ1900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:15:34 PM Thursday, March 28, 2013

Page 160 of 789

HFH2
DESIGN NOTES

4:15:34 PM Thursday, March 28, 2013

Page 161 of 789

HFH3

HFH3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFREACH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

760

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF1

Question Text:

What about reaching or extending arms above shoulder level?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:35 PM Thursday, March 28, 2013

Page 162 of 789

HFH3

Field1:

DIFREACH

( HFQ1900 )

HEST.DIFREACH

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH4 - DIFWRITE ( HFQ1910 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH4 - DIFWRITE ( HFQ1910 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH4 - DIFWRITE ( HFQ1910 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH4 - DIFWRITE ( HFQ1910 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH4 - DIFWRITE ( HFQ1910 )

English text: NOT ABLE TO DO IT
Attribute

Route

Don't know

HFH4 - DIFWRITE ( HFQ1910 )

Refusal

HFH4 - DIFWRITE ( HFQ1910 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:15:37 PM Thursday, March 28, 2013

Page 163 of 789

HFH3
DESIGN NOTES

4:15:37 PM Thursday, March 28, 2013

Page 164 of 789

HFH4

HFH4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFWRITE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

770

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF1

Question Text:

How much difficulty, if any, [do you/does (SP)] have either writing or
handling and grasping small objects?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:38 PM Thursday, March 28, 2013

Page 165 of 789

HFH4

Field1:

DIFWRITE

( HFQ1910 )

HEST.DIFWRITE

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH5 - DIFWALK ( HFQ1920 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH5 - DIFWALK ( HFQ1920 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH5 - DIFWALK ( HFQ1920 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH5 - DIFWALK ( HFQ1920 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH5 - DIFWALK ( HFQ1920 )

English text: NOT ABLE TO DO IT
Attribute

Route

Don't know

HFH5 - DIFWALK ( HFQ1920 )

Refusal

HFH5 - DIFWALK ( HFQ1920 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:15:39 PM Thursday, March 28, 2013

Page 166 of 789

HFH4
DESIGN NOTES

4:15:39 PM Thursday, March 28, 2013

Page 167 of 789

HFH5

HFH5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

780

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF1

Question Text:

What about walking a quarter of a mile - that is, about 2 or 3 blocks?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:40 PM Thursday, March 28, 2013

Page 168 of 789

HFH5

Field1:

DIFWALK

( HFQ1920 )

HEST.DIFWALK

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFH1 - (HFQ1932 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

BOX HFH1 - (HFQ1932 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

BOX HFH1 - (HFQ1932 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

BOX HFH1 - (HFQ1932 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

BOX HFH1 - (HFQ1932 )

English text: NOT ABLE TO DO IT
Attribute

Route

Don't know

BOX HFH1 - (HFQ1932 )

Refusal

BOX HFH1 - (HFQ1932 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:15:42 PM Thursday, March 28, 2013

Page 169 of 789

HFH5
DESIGN NOTES

4:15:42 PM Thursday, March 28, 2013

Page 170 of 789

BOX HFH1

BOX HFH1

Page Order # :

810

BOX INSTRUCTIONS
( HFQ1932 )

IF THIS IS ROUND 67, GO TO HFH10INT - PHYSACTINTRO ( HFQ1935 ).
ELSE GO TO HFJINTRO - MEDCONDINTRO ( HFQ2060 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:42 PM Thursday, March 28, 2013

Page 171 of 789

HFH10INT

HFH10INT

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PHYSACTINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

850

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

We are interested in two types of physical activity - vigorous and
moderate. Vigorous activities cause large increases in breathing or
heart rate. Moderate activities cause small increases in breathing or
heart rate. First I will ask about the vigorous activities that [you
do/(SP) does].

Int. Instr II:

INPUT FIELDS / ROUTING

4:15:43 PM Thursday, March 28, 2013

Page 172 of 789

HFH10INT

Field1:

PHYSACTINTRO

Cheshire Name:

( HFQ1935 )

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
HFH10 - VIGUNIT ( HFQ1945 )

English text: CONTINUE
Attribute

Route

Empty

HFH10 - VIGUNIT ( HFQ1945 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:44 PM Thursday, March 28, 2013

Page 173 of 789

HFH10

HFH10

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

VIGUNIT

Field 2:

VIGNUM

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

860

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If respondent is SP, display "you do".
Else display "(SP) does".

Multi Field display:

Vertical Alignment

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

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

In a typical week, how much time [do you/does (SP)] spend doing
vigorous activities, such as team sports, running, aerobics, heavy
house or yard work, or anything else that causes large increases in
breathing or heart rate?

Int. Instr II:

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.

4:15:45 PM Thursday, March 28, 2013

Page 174 of 789

HFH10
INPUT FIELDS / ROUTING
VIGUNIT

Field1:
Cheshire Name:
Item Text display:

( HFQ1945 )

HEST.VIGUNIT
Display response options in the following order: 96, 1, 2, 3,
4.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TVigunit
1
No
No

Number Label
1 NumberOfMinutesPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH10 - VIGNUM ( HFQ1955 )

2

English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH10 - VIGNUM ( HFQ1955 )

3

English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH10 - VIGNUM ( HFQ1955 )

4

English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH10 - VIGNUM ( HFQ1955 )

96

English text: NUMBER OF HOURS PER MONTH
None
HFH11 - MODUNIT ( HFQ1965 )
English text: NONE

Attribute
Don't know

Route
HFH11 - MODUNIT ( HFQ1965 )

Refusal

HFH11 - MODUNIT ( HFQ1965 )

4:15:47 PM Thursday, March 28, 2013

Page 175 of 789

HFH10

Field2:
Cheshire Name:

VIGNUM

( HFQ1955 )

HEST.VIGNUM

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

NUMBER:
Left

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

Integer
Tvignum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

3
1
999

Route
HFH11 - MODUNIT ( HFQ1965 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If VIGUNIT = 1/NumberOfMinutesPerDay, then VIGNUM = 1-90.

Else if VIGUNIT = 2/NumberOfHoursPerDay, then VIGNUM = 1-5.

Else if VIGUNIT = 3/NumberOfHoursPerWeeK, VIGNUM = 1-35.

Else if VIGUNIT = 4/NumberOfHoursPerMonth, VIGNUM = 1-150.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1:

If VIGUNIT = 1/NumberOfMinutesPerDay, then VIGNUM = 1-120.

Else if VIGUNIT = 2/NumberOfHoursPerDay, then VIGNUM = 1-8.

Else if VIGUNIT = 3/NumberOfHoursPerWeeK, VIGNUM = 1-56.

Else if VIGUNIT = 4/NumberOfHoursPerMonth, VIGNUM = 1-224.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER IN NOT VALID. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

4:15:48 PM Thursday, March 28, 2013

Page 176 of 789

HFH11

HFH11

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

MODUNIT

Field 2:

MODNUM

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

870

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

In a typical week, how much time [do you/does (SP)] spend doing
moderate activities, such as brisk walking, bicycling, gardening, golf,
swimming, or vacuuming?

Int. Instr II:

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.

INPUT FIELDS / ROUTING

4:15:49 PM Thursday, March 28, 2013

Page 177 of 789

HFH11

Field1:

MODUNIT

Cheshire Name:
Item Text display:

( HFQ1965 )

HEST.MODUNIT
Display response options in the following order: 96, 1, 2, 3,
4.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TVigunit
1
No
No

Number Label
1 NumberOfMinutesPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH11 - MODNUM ( HFQ1975 )

2

English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH11 - MODNUM ( HFQ1975 )

3

English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH11 - MODNUM ( HFQ1975 )

4

English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH11 - MODNUM ( HFQ1975 )

96

English text: NUMBER OF HOURS PER MONTH
None
HFH12 - MUSUNIT ( HFQ1985 )
English text: NONE

Attribute
Don't know

Route
HFH12 - MUSUNIT ( HFQ1985 )

Refusal

HFH12 - MUSUNIT ( HFQ1985 )

4:15:52 PM Thursday, March 28, 2013

Page 178 of 789

HFH11

Field2:
Cheshire Name:

MODNUM

( HFQ1975 )

HEST.MODNUM

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

NUMBER:
Left

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

Integer
Tvignum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

3
1
999

Route
HFH12 - MUSUNIT ( HFQ1985 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If MODUNIT = 1/NumberOfMinutesPerDay, then MODNUM = 1-90.

Else if MODUNIT = 2/NumberOfHoursPerDay, then MODNUM = 1­
5.

Else if MODUNIT = 3/NumberOfHoursPerWeeK, MODNUM = 1-35.

Else if MODUNIT = 4/NumberOfHoursPerMonth, MODNUM = 1-150.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1:

If MODUNIT = 1/NumberOfMinutesPerDay, then MODNUM = 1-120.

Else if MODUNIT = 2/NumberOfHoursPerDay, then MODNUM = 1­
8.

Else if MODUNIT = 3/NumberOfHoursPerWeeK, MODNUM = 1-56.

Else if MODUNIT = 4/NumberOfHoursPerMonth, MODNUM = 1-224.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER IN NOT VALID. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

4:15:52 PM Thursday, March 28, 2013

Page 179 of 789

HFH12

HFH12

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

MUSUNIT

Field 2:

MUSNUM

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

880

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now I’m going to ask you about activities [you/(SP)] may do to
increase (your/his/her) muscle strength or flexibility.
In a typical week, how much time [do you/does (SP)] spend doing
exercises to increase (your/his/her) muscle strength or flexibility,
such as lifting weights, push-ups, sit-ups, stretching, or yoga?

Int. Instr II:

4:15:53 PM Thursday, March 28, 2013

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.

Page 180 of 789

HFH12
INPUT FIELDS / ROUTING
MUSUNIT

Field1:
Cheshire Name:
Item Text display:

( HFQ1985 )

HEST.MUSUNIT
Display response options in the following order: 96, 1, 2, 3,
4.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TVigunit
1
No
No

Number Label
1 NumberOfMinutesPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH12 - MUSNUM ( HFQ1995 )

2

English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH12 - MUSNUM ( HFQ1995 )

3

English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH12 - MUSNUM ( HFQ1995 )

4

English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH12 - MUSNUM ( HFQ1995 )

96

English text: NUMBER OF HOURS PER MONTH
None
HFJINTRO - MEDCONDINTRO ( HFQ2060 )
English text: NONE

Attribute

Route

Don't know

HFJINTRO - MEDCONDINTRO ( HFQ2060 )

Refusal

HFJINTRO - MEDCONDINTRO ( HFQ2060 )

4:15:55 PM Thursday, March 28, 2013

Page 181 of 789

HFH12

Field2:
Cheshire Name:

MUSNUM

( HFQ1995 )

HEST.MUSNUM

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

NUMBER:
Left

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

Integer
Tvignum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

3
1
999

Route
HFJINTRO - MEDCONDINTRO ( HFQ2060 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If MUSUNIT = 1/NumberOfMinutesPerDay, then MUSNUM = 1-90.

Else if MUSUNIT = 2/NumberOfHoursPerDay, then MUSNUM = 1-5.

Else if MUSUNIT = 3/NumberOfHoursPerWeeK, MUSNUM = 1-35.

Else if MUSUNIT = 4/NumberOfHoursPerMonth, MUSNUM = 1-150.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1:

If MUSUNIT = 1/NumberOfMinutesPerDay, then MUSNUM = 1-120.

Else if MUSUNIT = 2/NumberOfHoursPerDay, then MUSNUM = 1-8.

Else if MUSUNIT = 3/NumberOfHoursPerWeeK, MUSNUM = 1-56.

Else if MUSUNIT = 4/NumberOfHoursPerMonth, MUSNUM = 1-224.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER IN NOT VALID. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

4:15:56 PM Thursday, March 28, 2013

Page 182 of 789

HFJINTRO

HFJINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

MEDCONDINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

890

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Next, I'm going to read a list of medical conditions. [Since (LAST HF
MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had any of these conditions?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:57 PM Thursday, March 28, 2013

Page 183 of 789

HFJINTRO

Field1:

MEDCONDINTRO

Cheshire Name:

( HFQ2060 )

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 HFJ1 - (HFQ2070 )

English text: CONTINUE
Attribute

Route

Empty

BOX HFJ1 - (HFQ2070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:15:58 PM Thursday, March 28, 2013

Page 184 of 789

BOX HFJ1

BOX HFJ1

Page Order # :

900

BOX INSTRUCTIONS
( HFQ2070 )

IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN
A PREVIOUS ROUND, GO TO HFJ2 - OCHBP ( HFQ2110 ).
ELSE GO TO HFJ1 - OCARTERY ( HFQ2080 ).

ASSIGNMENTS

TECHNICAL NOTES
390

HFHardenArtery

SP has ever reported having hardening of the arteries in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTERY = 1/Yes.

DESIGN NOTES

4:15:58 PM Thursday, March 28, 2013

Page 185 of 789

HFJ1

HFJ1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCARTERY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

910

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...
hardening of the arteries or arteriosclerosis?

Int. Instr II:
INPUT FIELDS / ROUTING
4:15:59 PM Thursday, March 28, 2013

Page 186 of 789

HFJ1

Field1:

( HFQ2080 )

OCARTERY

Cheshire Name:

HEST.OCARTERY

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ2 - OCHBP ( HFQ2110 )

English text: YES
No

HFJ2 - OCHBP ( HFQ2110 )

English text: NO
Attribute

Route

Don't know

HFJ2 - OCHBP ( HFQ2110 )

Refusal

HFJ2 - OCHBP ( HFQ2110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:16:00 PM Thursday, March 28, 2013

Page 187 of 789

HFJ2

HFJ2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCHBP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

930

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP reported having hypertension in the previous round then:
If SP is respondent, display "still have".
Else display "still has".
Else then:
If SP is respondent, display "have".
Else display "had".
If HFJ1 - OCARTERY was asked in the current round, display first
line, "[Since...]", in brackets.
Else do not display first line in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:
4:16:01 PM Thursday, March 28, 2013

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
Page 188 of 789

HFJ2
[you/(SP)] that (you/he/she) (still have/still has/have/had)...]
hypertension, sometimes called high blood pressure?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

OCHBP

Cheshire Name:
Item Text display:

( HFQ2110 )

HEST.OCHBP

Do not display response option 3/NoButOriginallyYes.

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TOchbp

1
No

No

Number Label
1 Yes

FieldSize:

Min Value:

Max Value:

Mask:

Route
BOX HFJ2 - (HFQ2140 )

2

English text: YES
No

3

English text: NO
NoButOriginallyYes

HFJ4 - OCMYOCAR ( HFQ2160 )

DO NOT DISPLAY. DATA EDITING ONLY.
English text: NO, BUT ORIGINALLY YES
Attribute

Route

Don't know

HFJ4 - OCMYOCAR ( HFQ2160 )

Refusal

HFJ4 - OCMYOCAR ( HFQ2160 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:16:02 PM Thursday, March 28, 2013

Page 189 of 789

HFJ2
TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

391

HFHypertension

SP reported having hypertension in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCHBP = 1/Yes.

DESIGN NOTES

4:16:02 PM Thursday, March 28, 2013

Page 190 of 789

BOX HFJ2

BOX HFJ2

Page Order # :

950

BOX INSTRUCTIONS
( HFQ2140 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ3 - YRHBP (
HFQ2150 ).
ELSE GO TO HFJ4 - OCMYOCAR ( HFQ2160 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:02 PM Thursday, March 28, 2013

Page 191 of 789

HFJ3

HFJ3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRHBP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

960

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) still had hypertension or high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:03 PM Thursday, March 28, 2013

Page 192 of 789

HFJ3

Field1:

YRHBP

Cheshire Name:

( HFQ2150 )

HEST.YRHBP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ4 - OCMYOCAR ( HFQ2160 )

English text: YES
No

HFJ4 - OCMYOCAR ( HFQ2160 )

English text: NO
Attribute

Route

Don't know

HFJ4 - OCMYOCAR ( HFQ2160 )

Refusal

HFJ4 - OCMYOCAR ( HFQ2160 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:04 PM Thursday, March 28, 2013

Page 193 of 789

HFJ4

HFJ4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCMYOCAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

970

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a myocardial infarction or heart attack?

Int. Instr II:

4:16:05 PM Thursday, March 28, 2013

Page 194 of 789

HFJ4
INPUT FIELDS / ROUTING
OCMYOCAR

Field1:
Cheshire Name:

( HFQ2160 )

HEST.OCMYOCAR

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ3 - (HFQ2190 )

English text: YES
No

HFJ6 - OCCHD ( HFQ2210 )

English text: NO
Attribute
Don't know

Route
HFJ6 - OCCHD ( HFQ2210 )

Refusal

HFJ6 - OCCHD ( HFQ2210 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:16:06 PM Thursday, March 28, 2013

Page 195 of 789

HFJ4

4:16:07 PM Thursday, March 28, 2013

Page 196 of 789

BOX HFJ3

BOX HFJ3

Page Order # :

990

BOX INSTRUCTIONS
( HFQ2190 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ5 - YRMYOCAR (
HFQ2200 ).
ELSE GO TO HFJ6 - OCCHD ( HFQ2210 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:07 PM Thursday, March 28, 2013

Page 197 of 789

HFJ5

HFJ5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRMYOCAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1000

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a myocardial infarction or heart attack?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:07 PM Thursday, March 28, 2013

Page 198 of 789

HFJ5

Field1:

YRMYOCAR

Cheshire Name:

( HFQ2200 )

HEST.YRMYOCAR

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ6 - OCCHD ( HFQ2210 )

English text: YES
No

HFJ6 - OCCHD ( HFQ2210 )

English text: NO
Attribute

Route

Don't know

HFJ6 - OCCHD ( HFQ2210 )

Refusal

HFJ6 - OCCHD ( HFQ2210 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:08 PM Thursday, March 28, 2013

Page 199 of 789

HFJ6

HFJ6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCHD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1010

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having angina pectoris or coronary heart
disease in a previous round, display "a new episode of". Display
"new" in BOLD
Else do not display.
Always display first line, "[Since..]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

4:16:09 PM Thursday, March 28, 2013

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 200 of 789

HFJ6
(a new episode of) angina pectoris or coronary heart disease?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

( HFQ2210 )

OCCHD

Cheshire Name:

HEST.OCCHD

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ4 - (HFQ2240 )

English text: YES
No

HFJ8 - OCCFAIL ( HFQ2260 )

English text: NO
Attribute

Route

Don't know

HFJ8 - OCCFAIL ( HFQ2260 )

Refusal

HFJ8 - OCCFAIL ( HFQ2260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:16:11 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 201 of 789

HFJ6
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

392

HFAngina

SP has ever reported having hardening angina pectoris
or coronary heart disease in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCHD = 1/Yes.

DESIGN NOTES

4:16:11 PM Thursday, March 28, 2013

Page 202 of 789

BOX HFJ4

BOX HFJ4

Page Order # :

1030

BOX INSTRUCTIONS
( HFQ2240 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ7 - YRCHD (
HFQ2250 ).
ELSE GO TO HFJ8 - OCCFAIL ( HFQ2260 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:11 PM Thursday, March 28, 2013

Page 203 of 789

HFJ7

HFJ7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCHD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1040

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of angina pectoris or coronary heart
disease?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:11 PM Thursday, March 28, 2013

Page 204 of 789

HFJ7

Field1:

YRCHD

Cheshire Name:

( HFQ2250 )

HEST.YRCHD

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ8 - OCCFAIL ( HFQ2260 )

English text: YES
No

HFJ8 - OCCFAIL ( HFQ2260 )

English text: NO
Attribute

Route

Don't know

HFJ8 - OCCFAIL ( HFQ2260 )

Refusal

HFJ8 - OCCFAIL ( HFQ2260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:13 PM Thursday, March 28, 2013

Page 205 of 789

HFJ8

HFJ8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCFAIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1050

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having congestive heart failure in a previous
round, display "a new episode of ". Display "new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

4:16:13 PM Thursday, March 28, 2013

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]

Page 206 of 789

HFJ8
(a new episode of) congestive heart failure?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

( HFQ2260 )

OCCFAIL

Cheshire Name:

HEST.OCCFAIL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ5 - (HFQ2280 )

English text: YES
No

HFJ10 - OCCVALVE ( HFQ2300 )

English text: NO
Attribute

Route

Don't know

HFJ10 - OCCVALVE ( HFQ2300 )

Refusal

HFJ10 - OCCVALVE ( HFQ2300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:16:15 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 207 of 789

HFJ8
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

393

HFCongHeartFailure

SP has ever reported having congestive heart failure in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCFAIL = 1/Yes.

DESIGN NOTES

4:16:15 PM Thursday, March 28, 2013

Page 208 of 789

BOX HFJ5

BOX HFJ5

Page Order # :

1060

BOX INSTRUCTIONS
( HFQ2280 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ9 - YRCFAIL (
HFQ2290 ).
ELSE GO TO HFJ10 - OCCVALVE ( HFQ2300 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:15 PM Thursday, March 28, 2013

Page 209 of 789

HFJ9

HFJ9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCFAIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1070

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of congestive heart failure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:16 PM Thursday, March 28, 2013

Page 210 of 789

HFJ9

Field1:

YRCFAIL

Cheshire Name:

( HFQ2290 )

HEST.YRCFAIL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ10 - OCCVALVE ( HFQ2300 )

English text: YES
No

HFJ10 - OCCVALVE ( HFQ2300 )

English text: NO
Attribute

Route

Don't know

HFJ10 - OCCVALVE ( HFQ2300 )

Refusal

HFJ10 - OCCVALVE ( HFQ2300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:17 PM Thursday, March 28, 2013

Page 211 of 789

HFJ10

HFJ10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCVALVE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1080

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having problems with the valves of the heart
in a previous round, display "a new episode of". Display "new" in
BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

4:16:18 PM Thursday, March 28, 2013

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 212 of 789

HFJ10
(a new episode of) problems with the valves of the heart, such as
aortic stenosis?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

( HFQ2300 )

OCCVALVE

Cheshire Name:

HEST.OCCVALVE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ6 - (HFQ2320 )

English text: YES
No

HFJ12 - OCRHYTHM ( HFQ2340 )

English text: NO
Attribute

Route

Don't know

HFJ12 - OCRHYTHM ( HFQ2340 )

Refusal

HFJ12 - OCRHYTHM ( HFQ2340 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:16:19 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
Page 213 of 789

HFJ10
where MRES.MRESRND = current round.
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

394

HFHeartValve

SP has ever reported having problems with the valves of
the heart in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCVALVE = 1/Yes.

DESIGN NOTES

4:16:19 PM Thursday, March 28, 2013

Page 214 of 789

BOX HFJ6

BOX HFJ6

Page Order # :

1090

BOX INSTRUCTIONS
( HFQ2320 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ11 - YRVALVE (
HFQ2330 ).
ELSE GO TO HFJ12 - OCRHYTHM ( HFQ2340 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:19 PM Thursday, March 28, 2013

Page 215 of 789

HFJ11

HFJ11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRVALVE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1100

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of problems with the valves of the
heart, such as aortic stenosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:20 PM Thursday, March 28, 2013

Page 216 of 789

HFJ11

Field1:

YRVALVE

Cheshire Name:

( HFQ2330 )

HEST.YRVALVE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ12 - OCRHYTHM ( HFQ2340 )

English text: YES
No

HFJ12 - OCRHYTHM ( HFQ2340 )

English text: NO
Attribute

Route

Don't know

HFJ12 - OCRHYTHM ( HFQ2340 )

Refusal

HFJ12 - OCRHYTHM ( HFQ2340 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:21 PM Thursday, March 28, 2013

Page 217 of 789

HFJ12

HFJ12

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCRHYTHM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having problems with the rhythm of the
heart in a previous round, display "a new episode of". Display "new"
in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

4:16:22 PM Thursday, March 28, 2013

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 218 of 789

HFJ12
(a new episode of) problems with the rhythm of (your/his/her)
heartbeat, such as atrial fibrillation?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

OCRHYTHM

Cheshire Name:

( HFQ2340 )

HEST.OCRHYTHM

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ7 - (HFQ2360 )

English text: YES
No

HFJ14 - OCOTHHRT ( HFQ2380 )

English text: NO
Attribute

Route

Don't know

HFJ14 - OCOTHHRT ( HFQ2380 )

Refusal

HFJ14 - OCOTHHRT ( HFQ2380 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:16:23 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
Page 219 of 789

HFJ12
where MRES.MRESRND = current round.
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

395

HFHeartRhythm

SP has ever reported having problems with the rhythm of
the heart in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCRHYTHM = 1/Yes.

DESIGN NOTES

4:16:23 PM Thursday, March 28, 2013

Page 220 of 789

BOX HFJ7

BOX HFJ7

Page Order # :

1120

BOX INSTRUCTIONS
( HFQ2360 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ13 - YRRHYTHM (
HFQ2370 ).
ELSE GO TO HFJ14 - OCOTHHRT ( HFQ2380 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:23 PM Thursday, March 28, 2013

Page 221 of 789

HFJ13

HFJ13

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRRHYTHM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1130

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of problems with the rhythm of
(your/his/her) heart, such as atrial fibrillation?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:24 PM Thursday, March 28, 2013

Page 222 of 789

HFJ13

Field1:

YRRHYTHM

Cheshire Name:

( HFQ2370 )

HEST.YRRHYTHM

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ14 - OCOTHHRT ( HFQ2380 )

English text: YES
No

HFJ14 - OCOTHHRT ( HFQ2380 )

English text: NO
Attribute

Route

Don't know

HFJ14 - OCOTHHRT ( HFQ2380 )

Refusal

HFJ14 - OCOTHHRT ( HFQ2380 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:25 PM Thursday, March 28, 2013

Page 223 of 789

HFJ14

HFJ14

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCOTHHRT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having any other heart condition in a
previous round, display "a new episode of". Display "new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

4:16:26 PM Thursday, March 28, 2013

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]

Page 224 of 789

HFJ14
(a new episode of) any other heart condition?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

( HFQ2380 )

OCOTHHRT

Cheshire Name:

HEST.OCOTHHRT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ8 - (HFQ2400 )

English text: YES
No

HFJ16 - OCSTROKE ( HFQ2440 )

English text: NO
Attribute

Route

Don't know

HFJ16 - OCSTROKE ( HFQ2440 )

Refusal

HFJ16 - OCSTROKE ( HFQ2440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:16:28 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 225 of 789

HFJ14
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

396

HFOtherHeart

SP has ever reported having any other heart condition in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCOTHHRT = 1/Yes.

DESIGN NOTES

4:16:28 PM Thursday, March 28, 2013

Page 226 of 789

BOX HFJ8

BOX HFJ8

Page Order # :

1150

BOX INSTRUCTIONS
( HFQ2400 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ15 - YROTHHRT (
HFQ2410 ).
ELSE GO TO HFJ16 - OCSTROKE ( HFQ2440 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:28 PM Thursday, March 28, 2013

Page 227 of 789

HFJ15

HFJ15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YROTHHRT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1160

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of any other heart condition?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:29 PM Thursday, March 28, 2013

Page 228 of 789

HFJ15

Field1:

YROTHHRT

Cheshire Name:

( HFQ2410 )

HEST.YROTHHRT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ16 - OCSTROKE ( HFQ2440 )

English text: YES
No

HFJ16 - OCSTROKE ( HFQ2440 )

English text: NO
Attribute

Route

Don't know

HFJ16 - OCSTROKE ( HFQ2440 )

Refusal

HFJ16 - OCSTROKE ( HFQ2440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:30 PM Thursday, March 28, 2013

Page 229 of 789

HFJ16

HFJ16

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCSTROKE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1190

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a stroke, a brain hemorrhage, or a cerebrovascular accident?

Int. Instr II:

4:16:31 PM Thursday, March 28, 2013

Page 230 of 789

HFJ16
INPUT FIELDS / ROUTING
( HFQ2440 )

OCSTROKE

Field1:
Cheshire Name:

HEST.OCSTROKE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ9 - (HFQ2460 )

English text: YES
No

HFJ17A - OCCHOLES ( HFQ2475 )

English text: NO
Attribute
Don't know

Route
HFJ17A - OCCHOLES ( HFQ2475 )

Refusal

HFJ17A - OCCHOLES ( HFQ2475 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:16:32 PM Thursday, March 28, 2013

Page 231 of 789

HFJ16

4:16:32 PM Thursday, March 28, 2013

Page 232 of 789

BOX HFJ9

BOX HFJ9

Page Order # :

1200

BOX INSTRUCTIONS
( HFQ2460 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ17 - YRSTROKE (
HFQ2470 ).
ELSE GO TO HFJ17A - OCCHOLES ( HFQ2475 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:32 PM Thursday, March 28, 2013

Page 233 of 789

HFJ17

HFJ17

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRSTROKE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1210

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a stroke, a brain hemorrhage, or a cerebrovascular
accident?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:33 PM Thursday, March 28, 2013

Page 234 of 789

HFJ17

Field1:

YRSTROKE

Cheshire Name:

( HFQ2470 )

HEST.YRSTROKE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ17A - OCCHOLES ( HFQ2475 )

English text: YES
No

HFJ17A - OCCHOLES ( HFQ2475 )

English text: NO
Attribute

Route

Don't know

HFJ17A - OCCHOLES ( HFQ2475 )

Refusal

HFJ17A - OCCHOLES ( HFQ2475 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:34 PM Thursday, March 28, 2013

Page 235 of 789

HFJ17A

HFJ17A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCHOLES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1215

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Has a doctor ever told [you/(SP)] that (you/he/she) had high
cholesterol?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:35 PM Thursday, March 28, 2013

Page 236 of 789

HFJ17A

Field1:

OCCHOLES

Cheshire Name:

( HFQ2475 )

HEST.OCCHOLES

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ17B - YRCHOLES ( HFQ2485 )

English text: YES
No

HFJ18 - OCCSKIN ( HFQ2490 )

English text: NO
Attribute

Route

Don't know

HFJ18 - OCCSKIN ( HFQ2490 )

Refusal

HFJ18 - OCCSKIN ( HFQ2490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:36 PM Thursday, March 28, 2013

Page 237 of 789

HFJ17B

HFJ17B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCHOLES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1220

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had high cholesterol?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:37 PM Thursday, March 28, 2013

Page 238 of 789

HFJ17B

Field1:

YRCHOLES

Cheshire Name:

( HFQ2485 )

HEST.YRCHOLES

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ18 - OCCSKIN ( HFQ2490 )

English text: YES
No

HFJ18 - OCCSKIN ( HFQ2490 )

English text: NO
Attribute

Route

Don't know

HFJ18 - OCCSKIN ( HFQ2490 )

Refusal

HFJ18 - OCCSKIN ( HFQ2490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:38 PM Thursday, March 28, 2013

Page 239 of 789

HFJ18

HFJ18

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCSKIN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has ever reported having skin cancer in a previous round,

display "I’ve recorded that [you/(SP)] previously..".

Else do not display.

If SP is in the Supplemental Sample, or SP skipped the previous

year interview, display "ever".

Else do not display.

If SP has ever reported having skin cancer in a previous round,

display "a new occurrence of". Display "new" in BOLD

Else do not display.

If SP has not ever reported having skin cancer in a previous round,

display first line of second sentence, "[Since...]", in brackets.

Else do not display in brackets.

Multi Field display:

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

TEXT:

4:16:39 PM Thursday, March 28, 2013

Page 240 of 789

HFJ18
HF REFERENCE DATE: (LAST HF MONTH YEAR)

Context Header:
Int. Instr I:

[I've recorded that [you/(SP)] previously reported having had skin
cancer.]

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
(a new occurrence of) skin cancer?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

OCCSKIN

Cheshire Name:

( HFQ2490 )

HEST.OCCSKIN

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ10 - (HFQ2510 )

English text: YES
No

HFJ20 - OCCANCER ( HFQ2540 )

English text: NO
Attribute

Route

Don't know

HFJ20 - OCCANCER ( HFQ2540 )

Refusal

HFJ20 - OCCANCER ( HFQ2540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

4:16:40 PM Thursday, March 28, 2013

Page 241 of 789

HFJ18
HARD EDIT CHECKS

TECHNICAL NOTES
398

HFSkinCancer

SP has ever reported having skin cancer in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCSKIN = 1/Yes.

9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:16:40 PM Thursday, March 28, 2013

Page 242 of 789

BOX HFJ10

BOX HFJ10

Page Order # :

1240

BOX INSTRUCTIONS
( HFQ2510 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ19 - YRCSKIN (
HFQ2520 ).
ELSE GO TO HFJ20 - OCCANCER ( HFQ2540 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:40 PM Thursday, March 28, 2013

Page 243 of 789

HFJ19

HFJ19

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCSKIN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1250

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an occurrence of skin cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:41 PM Thursday, March 28, 2013

Page 244 of 789

HFJ19

Field1:

YRCSKIN

Cheshire Name:

( HFQ2520 )

HEST.YRCSKIN

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ20 - OCCANCER ( HFQ2540 )

English text: YES
No

HFJ20 - OCCANCER ( HFQ2540 )

English text: NO
Attribute

Route

Don't know

HFJ20 - OCCANCER ( HFQ2540 )

Refusal

HFJ20 - OCCANCER ( HFQ2540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:42 PM Thursday, March 28, 2013

Page 245 of 789

HFJ20

HFJ20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCANCER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1270

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has ever reported having had a tumor, growth or cancer in a
previous round, display "I’ve recorded that [you/(SP)] previously
reported...". Display "[READ RESPONSES BELOW]" in the same
blue font used for interviewer instructions.
Else do not display.
If SP is in the Supplemental Sample, or SP skipped the previous

year interview, display "Has a doctor (ever) told ..."

Else display "Since…"

If SP has ever reported having had a tumor, growth or cancer in a

previous round, display "other".

Else do not display.

Display "other than skin cancer" in BOLD.

Multi Field display:

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

Display report below Question Text.
Display English response text to all responses included in
HEST.OCCCODE during any round.

4:16:43 PM Thursday, March 28, 2013

Page 246 of 789

HFJ20
If the only response to HEST.OCCCODE = DK or RF, display
“Unknown”
Else for each response included in HEST.OCCCODE, display
response on a separate line in the report:
If HEST.OCCCODE includes 1/Lung, display “Lung”.
If HEST.OCCCODE includes 2/Colon, display “Colon, Rectum, or
Bowel”.
If HEST.OCCCODE includes 3/Breast, display “Breast”
If HEST.OCCCODE includes 4/Uterus, display “Uterus”.
If HEST.OCCCODE includes 5/Prostate, display “Prostate”.
If HEST.OCCCODE includes 6/Bladder, display “Bladder”.
If HEST.OCCCODE includes 7/Ovary, display “Ovary”.
If HEST.OCCCODE includes 8/Stomach, display “Stomach”.
If HEST.OCCCODE includes 9/Cervix, display “Cervix”.
If HEST.OCCCODE includes 10/Brain, display Brain”
If HEST.OCCCODE includes 11/Kidney, display “Kidney”
If HEST.OCCCODE includes 12/Throat, display “Throat”
If HEST.OCCCODE includes 13/Head, display “Head”
If HEST.OCCCODE includes 14/Back, display “Back”
If HEST.OCCCODE includes 15/FemalOrgansNotListed, display
“Other Female Reproductive Organs”
If HEST.OCCCODE includes 91/Other, display HEST.OCCOS text.

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[I've recorded that [you/(SP)] previously reported having had a
tumor, growth, or cancer of the [READ RESPONSES BELOW].]
[Has a doctor (ever) told [you/(SP)] that (you/he/she) had/Since
(LAST HF MONTH YEAR), has a doctor told [you/(SP)] that
(you/he/she) had] any (other) kind of cancer, malignancy, or tumor
other than skin cancer?

Int. Instr II:

INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR
GROWTHS.

INPUT FIELDS / ROUTING

4:16:43 PM Thursday, March 28, 2013

Page 247 of 789

HFJ20

Field1:

OCCANCER

Cheshire Name:

( HFQ2540 )

HEST.OCCANCER

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ11 - (HFQ2560 )

English text: YES
No

BOX HFJ13 - (HFQ2620 )

English text: NO
Attribute

Route

Don't know

BOX HFJ13 - (HFQ2620 )

Refusal

BOX HFJ13 - (HFQ2620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

4:16:45 PM Thursday, March 28, 2013

Page 248 of 789

HFJ20
412

HFTumorGrowth

SP has ever reported having had a tumor, growth or
cancer in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCANCER = 1/Yes.

DESIGN NOTES

4:16:45 PM Thursday, March 28, 2013

Page 249 of 789

BOX HFJ11

BOX HFJ11

Page Order # :

1280

BOX INSTRUCTIONS
( HFQ2560 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ21 - YRCANCER (
HFQ2570 ).
ELSE GO TO HFJ22 - OCCCODE ( HFQ2575 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:16:45 PM Thursday, March 28, 2013

Page 250 of 789

HFJ21

HFJ21

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCANCER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1290

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "other than skin cancer" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had any kind of cancer, malignancy, or tumor other
than skin cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:45 PM Thursday, March 28, 2013

Page 251 of 789

HFJ21

Field1:

YRCANCER

Cheshire Name:

( HFQ2570 )

HEST.YRCANCER

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ22 - OCCCODE ( HFQ2575 )

English text: YES
No

HFJ22 - OCCCODE ( HFQ2575 )

English text: NO
Attribute

Route

Don't know

HFJ22 - OCCCODE ( HFQ2575 )

Refusal

HFJ22 - OCCCODE ( HFQ2575 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:47 PM Thursday, March 28, 2013

Page 252 of 789

HFJ22

HFJ22

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

OCCCODE

Field 2:

OCCOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

1300

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFJ21 - YRCANCER = 1/Yes, display "Since the first time a
doctor told [you/(SP)] that (you/he/she) had a cancer, malignancy,
or tumor, on".
Else display "On".

Multi Field display:

Vertical Alignment

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

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

[Since the first time a doctor told [you/(SP)] that (you/he/she) had a
cancer, malignancy, or tumor, on/On] what part or parts of
[your/(SP's)] body was the cancer or tumor found?
[PROBE: Any other part?]

4:16:48 PM Thursday, March 28, 2013

Page 253 of 789

HFJ22
Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:16:50 PM Thursday, March 28, 2013

Page 254 of 789

HFJ22

Field1:

OCCCODE

Cheshire Name:

( HFQ2575 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.OCCLUNG
2=HEST.OCCCOLON
3=HEST.OCCBREST
4=HEST.OCCUTER
5=HEST.OCCPROST
6=HEST.OCCBLAD
7=HEST.OCCOVARY
8=HEST.OCCSTOM
9=HEST.OCCCERVX
10=HEST.OCCBRAIN
11=HEST.OCCKIDNY
12=HEST.OCCTHROA
13=HEST.OCCHEAD
14=HEST.OCCBACK
15=HEST.OCCFONEC
91=HEST.OCCOTHER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TOccCode
16
No
No

Number Label
1 Lung

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ13 - (HFQ2620 )

2

English text: LUNG
Colon

3

English text: COLON, RECTUM, OR BOWEL
Breast
BOX HFJ13 - (HFQ2620 )

4

English text: BREAST
Uterus

BOX HFJ13 - (HFQ2620 )

5

English text: UTERUS
Prostate

BOX HFJ13 - (HFQ2620 )

6

English text: PROSTATE
Bladder

BOX HFJ13 - (HFQ2620 )

BOX HFJ13 - (HFQ2620 )

English text: BLADDER

4:16:53 PM Thursday, March 28, 2013

Page 255 of 789

HFJ22

7

Ovary

BOX HFJ13 - (HFQ2620 )

8

English text: OVARY
Stomach

BOX HFJ13 - (HFQ2620 )

9

English text: STOMACH
Cervix

BOX HFJ13 - (HFQ2620 )

10

English text: CERVIX
Brain

BOX HFJ13 - (HFQ2620 )

11

English text: BRAIN
Kidney

BOX HFJ13 - (HFQ2620 )

12

English text: KIDNEY
Throat

BOX HFJ13 - (HFQ2620 )

13

English text: THROAT
Head

BOX HFJ13 - (HFQ2620 )

14

English text: HEAD
Back

BOX HFJ13 - (HFQ2620 )

15

English text: BACK
FemaleOrgansNotListed

BOX HFJ13 - (HFQ2620 )

91

English text: OTHER FEMALE REPRODUCTIVE ORGANS
Other
HFJ22 - OCCOS ( HFQ2576 )
English text: OTHER

Attribute

Route

Don't know

BOX HFJ13 - (HFQ2620 )

Refusal

BOX HFJ13 - (HFQ2620 )

4:16:56 PM Thursday, March 28, 2013

Page 256 of 789

HFJ22

Field2:
Cheshire Name:

OCCOS

( HFQ2576 )

HEST.OCCOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFJ13 - (HFQ2620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:57 PM Thursday, March 28, 2013

Page 257 of 789

BOX HFJ13

BOX HFJ13

Page Order # :

1330

BOX INSTRUCTIONS
( HFQ2620 )

IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND, GO TO BOX HFJ14 - (HFQ2650 ).
ELSE GO TO HFJ24 - OCARTHRH ( HFQ2630 ).

ASSIGNMENTS

TECHNICAL NOTES
397

HFRheumArthritis

SP has ever reported having rheumatoid arthritis in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTHRH = 1/Yes.

DESIGN NOTES

4:16:57 PM Thursday, March 28, 2013

Page 258 of 789

HFJ24

HFJ24

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCARTHRH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1340

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
rheumatoid arthritis?

Int. Instr II:

4:16:57 PM Thursday, March 28, 2013

Page 259 of 789

HFJ24
INPUT FIELDS / ROUTING
OCARTHRH

Field1:
Cheshire Name:

( HFQ2630 )

HEST.OCARTHRH

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ14 - (HFQ2650 )

English text: YES
No

BOX HFJ14 - (HFQ2650 )

English text: NO
Attribute
Don't know

Route
BOX HFJ14 - (HFQ2650 )

Refusal

BOX HFJ14 - (HFQ2650 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:16:59 PM Thursday, March 28, 2013

Page 260 of 789

HFJ24

4:16:59 PM Thursday, March 28, 2013

Page 261 of 789

BOX HFJ14

BOX HFJ14

Page Order # :

1350

BOX INSTRUCTIONS
( HFQ2650 )

IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN
RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND, GO TO BOX HFJ16 ­
(HFQ2720 ).
ELSE GO TO HFJ25 - OCARTH ( HFQ2670 ).

ASSIGNMENTS

TECHNICAL NOTES
399

HFOtherArthritis

SP has ever reported having arthritis other than
rheumatoid arthritis in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTH = 1/Yes.

DESIGN NOTES

4:16:59 PM Thursday, March 28, 2013

Page 262 of 789

HFJ25

HFJ25

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCARTH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1370

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
arthritis, other than rheumatoid arthritis?
[EXPLAIN IF NECESSARY: This includes osteoarthritis.]

4:16:59 PM Thursday, March 28, 2013

Page 263 of 789

HFJ25
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2670 )

OCARTH

Field1:
Cheshire Name:

HEST.OCARTH

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ15 - (HFQ2690 )

English text: YES
No

BOX HFJ16 - (HFQ2720 )

English text: NO
Attribute

Route

Don't know

BOX HFJ16 - (HFQ2720 )

Refusal

BOX HFJ16 - (HFQ2720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:17:01 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 264 of 789

HFJ25
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:17:01 PM Thursday, March 28, 2013

Page 265 of 789

BOX HFJ15

BOX HFJ15

Page Order # :

1380

BOX INSTRUCTIONS
( HFQ2690 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD (
HFQ2700 ).
ELSE GO TO BOX HFJ16A - (HFQ2735 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:01 PM Thursday, March 28, 2013

Page 266 of 789

HFJ26

HFJ26

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRARTHRD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1390

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had arthritis, other than rheumatoid arthritis, in any part
of (your/his/her) body?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:02 PM Thursday, March 28, 2013

Page 267 of 789

HFJ26

Field1:

YRARTHRD

Cheshire Name:

( HFQ2700 )

HEST.YRARTHRD

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ16 - (HFQ2720 )

English text: YES
No

BOX HFJ16 - (HFQ2720 )

English text: NO
Attribute

Route

Don't know

BOX HFJ16 - (HFQ2720 )

Refusal

BOX HFJ16 - (HFQ2720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:03 PM Thursday, March 28, 2013

Page 268 of 789

BOX HFJ16

BOX HFJ16

Page Order # :

1410

BOX INSTRUCTIONS
( HFQ2720 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ28 - OCMENTAL (
HFQ2730 ).
ELSE GO TO BOX HFJ16A - (HFQ2735 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:03 PM Thursday, March 28, 2013

Page 269 of 789

HFJ28

HFJ28

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCMENTAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1420

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display first line, "[Has a doctor...]", in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Has a doctor ever told [you/(SP)] that (you/he/she) had...]

an intellectual disability, sometimes called mental retardation?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:03 PM Thursday, March 28, 2013

Page 270 of 789

HFJ28

Field1:

OCMENTAL

Cheshire Name:

( HFQ2730 )

HEST.OCMENTAL

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ16A - (HFQ2735 )

English text: YES
No

BOX HFJ16A - (HFQ2735 )

English text: NO
Attribute

Route

Don't know

BOX HFJ16A - (HFQ2735 )

Refusal

BOX HFJ16A - (HFQ2735 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:04 PM Thursday, March 28, 2013

Page 271 of 789

BOX HFJ16A

BOX HFJ16A

Page Order # :

1425

BOX INSTRUCTIONS
( HFQ2735 )

IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A
PREVIOUS ROUND, GO TO HFJ30AA - OCDEPRSS ( HFQ2775 ).
ELSE GO TO HFJ29A - OCALZMER ( HFQ2745 ).

ASSIGNMENTS

TECHNICAL NOTES
400

HFAlzheimers

SP has ever reported Alzheimer’s disease in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCALZMER = 1/Yes.

DESIGN NOTES

4:17:04 PM Thursday, March 28, 2013

Page 272 of 789

HFJ29A

HFJ29A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCALZMER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1430

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Alzheimer's disease?

Int. Instr II:

4:17:05 PM Thursday, March 28, 2013

Page 273 of 789

HFJ29A
INPUT FIELDS / ROUTING
( HFQ2745 )

OCALZMER

Field1:
Cheshire Name:

HEST.OCALZMER

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ30AA - OCDEPRSS ( HFQ2775 )

English text: YES
No

BOX HFJ16B - (HFQ2755 )

English text: NO
Attribute
Don't know

Route
BOX HFJ16B - (HFQ2755 )

Refusal

BOX HFJ16B - (HFQ2755 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:17:07 PM Thursday, March 28, 2013

Page 274 of 789

HFJ29A

4:17:07 PM Thursday, March 28, 2013

Page 275 of 789

BOX HFJ16B

BOX HFJ16B

Page Order # :

1435

BOX INSTRUCTIONS
( HFQ2755 )

IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS
ROUND, GO TO HFJ30AA - OCDEPRSS ( HFQ2775 ).
ELSE GO TO HFJ29B - OCDEMENT ( HFQ2765 ).

ASSIGNMENTS

TECHNICAL NOTES
401

HFDementia

SP has ever reported having dementia in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCDEMENT = 1/Yes.

DESIGN NOTES

4:17:07 PM Thursday, March 28, 2013

Page 276 of 789

HFJ29B

HFJ29B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCDEMENT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1440

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
any type of dementia other than Alzheimer's disease?

Int. Instr II:

4:17:07 PM Thursday, March 28, 2013

Page 277 of 789

HFJ29B
INPUT FIELDS / ROUTING
OCDEMENT

Field1:
Cheshire Name:

( HFQ2765 )

HEST.OCDEMENT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ30AA - OCDEPRSS ( HFQ2775 )

English text: YES
No

HFJ30AA - OCDEPRSS ( HFQ2775 )

English text: NO
Attribute
Don't know

Route
HFJ30AA - OCDEPRSS ( HFQ2775 )

Refusal

HFJ30AA - OCDEPRSS ( HFQ2775 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:17:09 PM Thursday, March 28, 2013

Page 278 of 789

HFJ29B

4:17:09 PM Thursday, March 28, 2013

Page 279 of 789

HFJ30AA

HFJ30AA

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCDEPRSS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1445

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
depression?

Int. Instr II:

4:17:09 PM Thursday, March 28, 2013

Page 280 of 789

HFJ30AA
INPUT FIELDS / ROUTING
( HFQ2775 )

OCDEPRSS

Field1:
Cheshire Name:

HEST.OCDEPRSS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ17A - (HFQ2785 )

English text: YES
No

HFJ30A - OCPSYCHO ( HFQ2805 )

English text: NO
Attribute
Don't know

Route
HFJ30A - OCPSYCHO ( HFQ2805 )

Refusal

HFJ30A - OCPSYCHO ( HFQ2805 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:17:11 PM Thursday, March 28, 2013

Page 281 of 789

HFJ30AA

4:17:11 PM Thursday, March 28, 2013

Page 282 of 789

BOX HFJ17A

BOX HFJ17A

Page Order # :

1450

BOX INSTRUCTIONS
( HFQ2785 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ30BB - YRDEPRSS
( HFQ2795 ).
ELSE GO TO HFJ30A - OCPSYCHO ( HFQ2805 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:11 PM Thursday, March 28, 2013

Page 283 of 789

HFJ30BB

HFJ30BB

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRDEPRSS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1455

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had depression?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:12 PM Thursday, March 28, 2013

Page 284 of 789

HFJ30BB

Field1:

YRDEPRSS

Cheshire Name:

( HFQ2795 )

HEST.YRDEPRSS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ30A - OCPSYCHO ( HFQ2805 )

English text: YES
No

HFJ30A - OCPSYCHO ( HFQ2805 )

English text: NO
Attribute

Route

Don't know

HFJ30A - OCPSYCHO ( HFQ2805 )

Refusal

HFJ30A - OCPSYCHO ( HFQ2805 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:13 PM Thursday, March 28, 2013

Page 285 of 789

HFJ30A

HFJ30A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCPSYCHO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1460

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a mental or psychiatric disorder other than depression?

Int. Instr II:

4:17:13 PM Thursday, March 28, 2013

Page 286 of 789

HFJ30A
INPUT FIELDS / ROUTING
OCPSYCHO

Field1:
Cheshire Name:

( HFQ2805 )

HEST.OCPSYCHO

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ17B - (HFQ2810 )

English text: YES
No

BOX HFJ19 - (HFQ2820 )

English text: NO
Attribute
Don't know

Route
BOX HFJ19 - (HFQ2820 )

Refusal

BOX HFJ19 - (HFQ2820 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:17:15 PM Thursday, March 28, 2013

Page 287 of 789

HFJ30A

4:17:15 PM Thursday, March 28, 2013

Page 288 of 789

BOX HFJ17B

BOX HFJ17B

Page Order # :

1465

BOX INSTRUCTIONS
( HFQ2810 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ31A - YRPSYCHO (
HFQ2815 ).
ELSE GO TO BOX HFJ19 - (HFQ2820 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:15 PM Thursday, March 28, 2013

Page 289 of 789

HFJ31A

HFJ31A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRPSYCHO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1470

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a mental or psychiatric disorder other than
depression?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:16 PM Thursday, March 28, 2013

Page 290 of 789

HFJ31A

Field1:

YRPSYCHO

Cheshire Name:

( HFQ2815 )

HEST.YRPSYCHO

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ19 - (HFQ2820 )

English text: YES
No

BOX HFJ19 - (HFQ2820 )

English text: NO
Attribute

Route

Don't know

BOX HFJ19 - (HFQ2820 )

Refusal

BOX HFJ19 - (HFQ2820 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:17 PM Thursday, March 28, 2013

Page 291 of 789

BOX HFJ19

BOX HFJ19

Page Order # :

1490

BOX INSTRUCTIONS
( HFQ2820 )

IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS
ROUND, GO TO HFJ33 - OCBRKHIP ( HFQ2860 ).
ELSE GO TO HFJ32 - OCOSTEOP ( HFQ2830 ).

ASSIGNMENTS

TECHNICAL NOTES
402

HFOsteoporosis

SP has ever reported having osteoporosis in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCOSTEOP = 1/Yes.

DESIGN NOTES

4:17:17 PM Thursday, March 28, 2013

Page 292 of 789

HFJ32

HFJ32

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCOSTEOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1500

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
osteoporosis, sometimes called fragile or soft bones?

Int. Instr II:

4:17:17 PM Thursday, March 28, 2013

Page 293 of 789

HFJ32
INPUT FIELDS / ROUTING
( HFQ2830 )

OCOSTEOP

Field1:
Cheshire Name:

HEST.OCOSTEOP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ33 - OCBRKHIP ( HFQ2860 )

English text: YES
No

HFJ33 - OCBRKHIP ( HFQ2860 )

English text: NO
Attribute
Don't know

Route
HFJ33 - OCBRKHIP ( HFQ2860 )

Refusal

HFJ33 - OCBRKHIP ( HFQ2860 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:17:19 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 294 of 789

HFJ32
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:17:19 PM Thursday, March 28, 2013

Page 295 of 789

HFJ33

HFJ33

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCBRKHIP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1520

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a broken hip?

Int. Instr II:

4:17:20 PM Thursday, March 28, 2013

Page 296 of 789

HFJ33
INPUT FIELDS / ROUTING
( HFQ2860 )

OCBRKHIP

Field1:
Cheshire Name:

HEST.OCBRKHIP

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ20 - (HFQ2880 )

English text: YES
No

BOX HFJ21 - (HFQ2900 )

English text: NO
Attribute
Don't know

Route
BOX HFJ21 - (HFQ2900 )

Refusal

BOX HFJ21 - (HFQ2900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:17:21 PM Thursday, March 28, 2013

Page 297 of 789

HFJ33

4:17:21 PM Thursday, March 28, 2013

Page 298 of 789

BOX HFJ20

BOX HFJ20

Page Order # :

1530

BOX INSTRUCTIONS
( HFQ2880 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ34 - YRBRKHIP (
HFQ2890 ).
ELSE GO TO BOX HFJ21 - (HFQ2900 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:21 PM Thursday, March 28, 2013

Page 299 of 789

HFJ34

HFJ34

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRBRKHIP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1540

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a broken hip?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:22 PM Thursday, March 28, 2013

Page 300 of 789

HFJ34

Field1:

YRBRKHIP

Cheshire Name:

( HFQ2890 )

HEST.YRBRKHIP

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ21 - (HFQ2900 )

English text: YES
No

BOX HFJ21 - (HFQ2900 )

English text: NO
Attribute

Route

Don't know

BOX HFJ21 - (HFQ2900 )

Refusal

BOX HFJ21 - (HFQ2900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:23 PM Thursday, March 28, 2013

Page 301 of 789

BOX HFJ21

BOX HFJ21

Page Order # :

1550

BOX INSTRUCTIONS
( HFQ2900 )

IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A
PREVIOUS ROUND, GO TO BOX HFJ22 - (HFQ2930 ).
ELSE GO TO HFJ35 - OCPARKIN ( HFQ2910 ).

ASSIGNMENTS

TECHNICAL NOTES
403

HFParkinsons

SP has ever reported having Parkinson’s disease in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCPARKIN = 1/Yes.

DESIGN NOTES

4:17:23 PM Thursday, March 28, 2013

Page 302 of 789

HFJ35

HFJ35

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCPARKIN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1560

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Parkinson's disease?

Int. Instr II:

4:17:23 PM Thursday, March 28, 2013

Page 303 of 789

HFJ35
INPUT FIELDS / ROUTING
( HFQ2910 )

OCPARKIN

Field1:
Cheshire Name:

HEST.OCPARKIN

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ22 - (HFQ2930 )

English text: YES
No

BOX HFJ22 - (HFQ2930 )

English text: NO
Attribute
Don't know

Route
BOX HFJ22 - (HFQ2930 )

Refusal

BOX HFJ22 - (HFQ2930 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:17:25 PM Thursday, March 28, 2013

Page 304 of 789

HFJ35

4:17:25 PM Thursday, March 28, 2013

Page 305 of 789

BOX HFJ22

BOX HFJ22

Page Order # :

1570

BOX INSTRUCTIONS
( HFQ2930 )

IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD
IN A PREVIOUS ROUND, GO TO HFJ37 - OCPPARAL ( HFQ2970 ).
ELSE GO TO HFJ36 - OCEMPHYS ( HFQ2940 ).

ASSIGNMENTS

TECHNICAL NOTES
404

HFEmphysema

SP has ever reported having emphysema, asthma, or
COPD in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCEMPHYS = 1/Yes.

DESIGN NOTES

4:17:25 PM Thursday, March 28, 2013

Page 306 of 789

HFJ36

HFJ36

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCEMPHYS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1580

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Display "COPD = CHRONIC OBSTRUCTIVE PULMONARY
DISEASE" in the same blue font used for interviewer instructions.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
emphysema, asthma, or COPD?

4:17:25 PM Thursday, March 28, 2013

Page 307 of 789

HFJ36
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Int. Instr II:
INPUT FIELDS / ROUTING

OCEMPHYS

Field1:
Cheshire Name:

( HFQ2940 )

HEST.OCEMPHYS

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ37 - OCPPARAL ( HFQ2970 )

English text: YES
No

HFJ37 - OCPPARAL ( HFQ2970 )

English text: NO
Attribute

Route

Don't know

HFJ37 - OCPPARAL ( HFQ2970 )

Refusal

HFJ37 - OCPPARAL ( HFQ2970 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:17:27 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 308 of 789

HFJ36
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:17:27 PM Thursday, March 28, 2013

Page 309 of 789

HFJ37

HFJ37

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCPPARAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1600

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:

IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY
PARALYZED, SELECT "YES" AND DO NOT ASK. OTHERWISE,

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
complete or partial paralysis?

Int. Instr II:
4:17:28 PM Thursday, March 28, 2013

Page 310 of 789

HFJ37
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2970 )

OCPPARAL

Field1:
Cheshire Name:

HEST.OCPPARAL

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ23 - (HFQ3000 )

English text: YES
No

BOX HFJ24 - (HFQ3020 )

English text: NO
Attribute

Route

Don't know

BOX HFJ24 - (HFQ3020 )

Refusal

BOX HFJ24 - (HFQ3020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:17:29 PM Thursday, March 28, 2013

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 311 of 789

HFJ37
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

405

HFParalysis

SP has ever reported having complete or partial paralysis
in a previous round round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCPPARAL = 1/Yes.

DESIGN NOTES

4:17:29 PM Thursday, March 28, 2013

Page 312 of 789

BOX HFJ23

BOX HFJ23

Page Order # :

1620

BOX INSTRUCTIONS
( HFQ3000 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ38 - YRPPARAL (
HFQ3010 ).
ELSE GO TO BOX HFJ24 - (HFQ3020 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:29 PM Thursday, March 28, 2013

Page 313 of 789

HFJ38

HFJ38

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRPPARAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1630

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had complete or partial paralysis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:30 PM Thursday, March 28, 2013

Page 314 of 789

HFJ38

Field1:

YRPPARAL

Cheshire Name:

( HFQ3010 )

HEST.YRPPARAL

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ24 - (HFQ3020 )

English text: YES
No

BOX HFJ24 - (HFQ3020 )

English text: NO
Attribute

Route

Don't know

BOX HFJ24 - (HFQ3020 )

Refusal

BOX HFJ24 - (HFQ3020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:31 PM Thursday, March 28, 2013

Page 315 of 789

BOX HFJ24

BOX HFJ24

Page Order # :

1640

BOX INSTRUCTIONS
( HFQ3020 )

IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN
A PREVIOUS ROUND, GO TO BOX HFJ25 - (HFQ3050 ).
ELSE GO TO HFJ39 - OCAMPUTE ( HFQ3030 ).

ASSIGNMENTS

TECHNICAL NOTES
406

HFAmpute

SP has ever reported an absence or loss of arm or leg in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCAMPUTE = 1/Yes.

DESIGN NOTES

4:17:31 PM Thursday, March 28, 2013

Page 316 of 789

HFJ39

HFJ39

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCAMPUTE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1650

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS,
SELECT "YES" AND DO NOT ASK. OTHERWISE, ASK:" in the
same blue font used for interviewer instructions.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT
"YES" AND DO NOT ASK. OTHERWISE, ASK:

Question Text:

What about absence or loss of an arm or a leg?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:32 PM Thursday, March 28, 2013

Page 317 of 789

HFJ39

Field1:

OCAMPUTE

Cheshire Name:

( HFQ3030 )

HEST.OCAMPUTE

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ25 - (HFQ3050 )

English text: YES
No

BOX HFJ25 - (HFQ3050 )

English text: NO
Attribute

Route

Don't know

BOX HFJ25 - (HFQ3050 )

Refusal

BOX HFJ25 - (HFQ3050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:33 PM Thursday, March 28, 2013

Page 318 of 789

BOX HFJ25

BOX HFJ25

Page Order # :

1660

BOX INSTRUCTIONS
( HFQ3050 )

IF SP IS FEMALE, GO TO HFJ41A - OCBETES ( HFQ3081 ).
ELSE GO TO HFJ40 - HAVEPROS ( HFQ3060 ).

ASSIGNMENTS

TECHNICAL NOTES
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:17:33 PM Thursday, March 28, 2013

Page 319 of 789

HFJ40

HFJ40

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HAVEPROS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1670

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Always display first line, "[Before [you/(SP)] had prostate surgery, did
a doctor ever tell/Since (LAST HF MONTH YEAR), has/Has]] a
doctor (ever) told] [you/(SP)] that (you/he) had ...]", in brackets.
If SP has ever reported having prostate surgery in the current round
or in a previous round, display "Before [you/(SP)] had prostate
surgery, did a doctor ever tell".
Else display "Since (LAST HF MONTH YEAR), has/Has]] a doctor
(ever) told".

Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Before [you/(SP)] had prostate surgery,
did a doctor ever tell/Since (LAST HF MONTH YEAR), has/Has]] a
doctor (ever) told] [you/(SP)] that (you/he) had ...]", in brackets.
If SP has ever reported having prostate surgery in the current round
or in a previous round, display "Before [you/(SP)] had prostate
surgery, did a doctor ever tell".
Else display "Since (LAST HF MONTH YEAR), has/Has]] a doctor
(ever) told".
If SP is the respondent, display "you".
Else display "he".
Always display "(BPH)" in parenthesis.

Multi Field display:

4:17:34 PM Thursday, March 28, 2013

Page 320 of 789

HFJ40

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

[[Before [you/(SP)] had prostate surgery, did a doctor ever tell/Since
(LAST HF MONTH YEAR), has/Has]] a doctor (ever) told ] [you/(SP)]
that (you/he) had...]
an enlarged prostate or benign prostatic hypertrophy (BPH)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:35 PM Thursday, March 28, 2013

Page 321 of 789

HFJ40

Field1:

( HFQ3060 )

HAVEPROS

Cheshire Name:

HEST.HAVEPROS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ26 - (HFQ3070 )

English text: YES
No

HFJ41A - OCBETES ( HFQ3081 )

English text: NO
Attribute

Route

Don't know

HFJ41A - OCBETES ( HFQ3081 )

Refusal

HFJ41A - OCBETES ( HFQ3081 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

4:17:36 PM Thursday, March 28, 2013

Page 322 of 789

HFJ40
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

387

HFProstateSurgCurrOr
Prev

If SP has ever reported having prostate surgery in the
current round or in a previous round =
(HEST.PROSSURG = /1Yes or HEST.PROSRMVD =
1/Yes ) on HEST where (HEST.HESTRND <= current
round).

DESIGN NOTES

4:17:36 PM Thursday, March 28, 2013

Page 323 of 789

BOX HFJ26

BOX HFJ26

Page Order # :

1680

BOX INSTRUCTIONS
( HFQ3070 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ41 - YRPROST (
HFQ3080 ).
ELSE GO TO HFJ41A - OCBETES ( HFQ3081 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:37 PM Thursday, March 28, 2013

Page 324 of 789

HFJ41

HFJ41

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRPROST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1690

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you".
Else display "he".
Always display "(BPH)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he) had an enlarged prostate or benign prostatic hypertrophy
(BPH)?

Int. Instr II:
INPUT FIELDS / ROUTING
4:17:37 PM Thursday, March 28, 2013

Page 325 of 789

HFJ41

Field1:

( HFQ3080 )

YRPROST

Cheshire Name:

HEST.YRPROST

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ41A - OCBETES ( HFQ3081 )

English text: YES
No

HFJ41A - OCBETES ( HFQ3081 )

English text: NO
Attribute

Route

Don't know

HFJ41A - OCBETES ( HFQ3081 )

Refusal

HFJ41A - OCBETES ( HFQ3081 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

4:17:39 PM Thursday, March 28, 2013

Page 326 of 789

HFJ41
DESIGN NOTES

4:17:39 PM Thursday, March 28, 2013

Page 327 of 789

HFJ41A

HFJ41A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCBETES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1692

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is female, display "borderline diabetes, pre-diabetes, or
pregnancy-related diabetes".
Else display "borderline diabetes, or pre-diabetes".

Multi Field display:

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

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

Has a doctor ever told [you/(SP)] that (you/he/she) had any type of
diabetes, including: sugar diabetes, high blood sugar, (borderline
diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes)?

Int. Instr II:
INPUT FIELDS / ROUTING
4:17:39 PM Thursday, March 28, 2013

Page 328 of 789

HFJ41A

Field1:

( HFQ3081 )

OCBETES

Cheshire Name:

HEST.OCBETES

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ41B - OCDTYPE ( HFQ3083 )

English text: YES
No

BOX HFJ27 - (HFQ3090 )

English text: NO
Attribute

Route

Don't know

BOX HFJ27 - (HFQ3090 )

Refusal

BOX HFJ27 - (HFQ3090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:17:40 PM Thursday, March 28, 2013

Page 329 of 789

HFJ41B

HFJ41B

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

OCDTYPE

Field 2:

OCDTYPOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

1694

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF6

Question Text:

Looking at this card, please tell me which type of diabetes the doctor
said that [you have/(SP) has].
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin
dependent” or “juvenile-onset” diabetes. This type of diabetes
usually develops during childhood or adolescence; but, it also can
develop in adults.
“Type 2” was formerly called “non-insulin dependent” or “adult-onset”
diabetes. Until recently, this type of diabetes was found only in

4:17:41 PM Thursday, March 28, 2013

Page 330 of 789

HFJ41B
adults; but, now it is also occurring in children.]
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

OCDTYPE

Cheshire Name:
Item Text display:

( HFQ3083 )

HEST.OCDTYPE
If SP is male, do not display response option 5/Gestational.

Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TOCDType

1
No
No

Number Label
1 TypeOne

FieldSize:

Min Value:

Max Value:

Mask:

Route
HFJ41C - OCDVISIT ( HFQ3087 )

2

English text: TYPE 1
TypeTwo

HFJ41C - OCDVISIT ( HFQ3087 )

3

English text: TYPE 2
Borderline

HFJ41C - OCDVISIT ( HFQ3087 )

4

English text: BORDERLINE
PreDiabetes

HFJ41C - OCDVISIT ( HFQ3087 )

5

English text: PRE-DIABETES
Gestational

HFJ41C - OCDVISIT ( HFQ3087 )

91

English text: GESTATIONAL (PREGNANCY-RELATED)
Other
HFJ41B - OCDTYPOS ( HFQ3085 )
English text: SOME OTHER TYPE

Attribute
Don't know

Route
HFJ41C - OCDVISIT ( HFQ3087 )

Refusal

HFJ41C - OCDVISIT ( HFQ3087 )

4:17:44 PM Thursday, March 28, 2013

Page 331 of 789

HFJ41B

Field2:

( HFQ3085 )

OCDTYPOS

Cheshire Name:

HEST.OCDTYPOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

SOME OTHER TYPE (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

30

Route
HFJ41C - OCDVISIT ( HFQ3087 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:17:44 PM Thursday, March 28, 2013

Page 332 of 789

HFJ41C

HFJ41C

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCDVISIT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1698

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Were you/Was (SP)] told on two or more different visits that
(you/he/she) had diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:45 PM Thursday, March 28, 2013

Page 333 of 789

HFJ41C

Field1:

OCDVISIT

Cheshire Name:

( HFQ3087 )

HEST.OCDVISIT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ27 - (HFQ3090 )

English text: YES
No

BOX HFJ27 - (HFQ3090 )

English text: NO
Attribute

Route

Don't know

BOX HFJ27 - (HFQ3090 )

Refusal

BOX HFJ27 - (HFQ3090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:46 PM Thursday, March 28, 2013

Page 334 of 789

BOX HFJ27

BOX HFJ27

4:17:46 PM Thursday, March 28, 2013

Page Order # :

1700

Page 335 of 789

BOX HFJ27
BOX INSTRUCTIONS
( HFQ3090 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF
CURRENT MEDICARE ELIGIBILITY WAS UNDER 65 THEN .
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO
HFJ42 - EMCOND ( HFQ3100 ).
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 ­
EMCAUSEVB ( HFQ3110 ).
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT
TIME OF CURRENT MEDICARE ELIGIBILITY WAS NOT UNDER 65 THEN
GO TO BOX HFP0 - (HFQ3175 ).
.

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

461

SPAgeCurrElig

SP's age at time of current Medicare eligibility was under
65 = BASE.AGECUREL < 65.

DESIGN NOTES
SP responded "YES" to at least one HFJ Condition where
HEST.HESTRND = current round=
IF HEST.OCARTERY = 1/Yes, or
HEST.OCHBP = 1/Yes, or
HEST.OCMYOCAR = 1/Yes, or
HEST.OCCHD = 1/Yes, or
HEST.OCCFAIL = 1/Yes, or
HEST.OCCVALVE = 1/Yes, or
HEST.OCRHYTHM = 1/Yes, or
HEST.OCOTHHRT = 1/Yes, or
HEST.OCSTROKE = 1/Yes, or
HEST.OCCSKIN = 1/Yes, or
HEST.OCCANCER = 1/Yes, or
HEST.OCARTHRH = 1/Yes, or
HEST.OCARTH = 1/Yes, or
HEST.OCMENTAL = 1/Yes, or
HEST.OCALZMER = 1/Yes, or
HEST.OCDEMENT = 1/Yes, or
HEST.OCDEPRSS = 1/Yes, or
HEST.OCPSYCHO = 1/Yes, or
HEST.OCOSTEOP = 1/Yes, or
HEST.OCBRKHIP = 1/Yes, or
HEST.OCPARKIN = 1/Yes, or
HEST.OCEMPHYS = 1/Yes, or
HEST.OCPPARAL = 1/Yes, or
HEST.OCAMPUTE = 1/Yes, or
HEST.OCBETES = 1/Yes.

4:17:46 PM Thursday, March 28, 2013

Page 336 of 789

BOX HFJ27
SP responded "NO" to all HFJ Conditions where HEST.HESTRND =

current round =

IF (HEST.OCARTERY =2/No, DK, OR RF), and

(HEST.OCHBP =2/No, DK, OR RF), and

(HEST. OCMYOCAR =2/No, DK, OR RF), and

(HEST.OCCHD =2/No, DK, OR RF), and

(HEST.OCCFAIL =2/No, DK, OR RF), and

(HEST.OCCVALVE =2/No, DK, OR RF), and

(HEST.OCRHYTHM =2/No, DK, OR RF), and

(HEST.OCOTHHRT =2/No, DK, OR RF), and

(HEST.OCSTROKE =2/No, DK, OR RF), and

(HEST.OCCSKIN =2/No, DK, OR RF), and

(HEST.OCCANCER =2/No, DK, OR RF), and

(HEST.OCARTHRH =2/No, DK, OR RF), and

(HEST.OCARTH =2/No, DK, OR RF), and

(HEST.OCMENTAL =2/No, DK, RF), and

(HEST.OCALZMER =2/No, DK, OR RF), and

(HEST.OCDEMENT =2/No, DK, OR RF), and

(HEST.OCDEPRSS =2/No, DK, OR RF), and

(HEST.OCPSYCHO =2/No, DK, OR RF), and

(HEST.OCOSTEOP =2/No, DK, OR RF), and

(HEST.OCBRKHIP =2/No, DK, OR RF), and

(HEST.OCPARKIN =2/No, DK, OR RF), and

(HEST.OCEMPHYS =2/No, DK, OR RF), and

(HEST.OCPPARAL =2/No, DK, OR RF), and

(HEST.OCAMPUTE =2/No, DK, OR RF), and

(HEST.OCBETES = 2/No, DK, OR RF).

NOTES:

We do not include a check for HEST.OCCHOLES since High Cholesterol

cannot be a reason for why SP is eligible for Medicare.

4:17:46 PM Thursday, March 28, 2013

Page 337 of 789

HFJ42

HFJ42

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EMCOND

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1710

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP Responded "YES" to only one HFJ condition in any round,
display "Was this".
Else display "Were any of these".

Multi Field display:

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

Display report below Question text.
For each HFJ condition reported in any round, where

HEST.HESTRND < = current round, display as a separate line in

report:

IF HEST.OCARTERY = 1/Yes in any round, display “ARTERIES

HARDENING”.

IF HEST.OCHBP = 1/Yes in any round, display “HYPERTENSION”.

IF HEST.OCMYOCAR = 1/Yes in any round, display “HEART

ATTACK”.

IF HEST.OCCHD = 1/Yes in any round, display “HEART DISEASE”.

IF HEST.OCCFAIL = 1/Yes in any round, display “CONGESTIVE

HEART FAILURE”.

IF HEST.OCCVALVE = 1/Yes in any round, display “HEART VALVE

PROBLEM”.

IF HEST.OCRHYTHM = 1/Yes in any round, display “HEART

4:17:47 PM Thursday, March 28, 2013

Page 338 of 789

HFJ42
RHYTHM PROBLEM”.
IF HEST.OCOTHHRT = 1/Yes in any round, display “OTHER
HEART PROBLEM”.
IF HEST.OCSTROKE = 1/Yes in any round, display “.STROKE OR
HEMORRHAGE”.
IF HEST.OCCSKIN = 1/Yes in any round, display “SKIN CANCER”.
IF HEST.OCCANCER = 1/Yes in any round, display
“CANCER/TUMOR”.
IF HEST.OCARTHRH = 1/Yes in any round, display “RHEUMATOID
ARTHRITIS”.
IF HEST.OCARTH = 1/Yes in any round, display “OTHER
ARTHRITIS”.
IF HEST.OCMENTAL = 1/Yes in any round, display “MENTAL
RETARDATION”.
IF HEST.OCALZMER = 1/Yes in any round, display “ALZHEIMER'S”.
IF HEST.OCDEMENT = 1/Yes in any round, display “DEMENTIA”.
IF HEST.OCDEPRSS = 1/Yes in any round, display “DEPRESSION”.
IF HEST.OCPSYCHO = 1/Yes in any round, display “MENTAL
DISORDER”.
IF HEST.OCOSTEOP = 1/Yes in any round, display
“OSTEOPOROSIS”.
IF HEST.OCBRKHIP = 1/Yes in any round, display “BROKEN HIP”.
IF HEST.OCPARKIN = 1/Yes in any round, display “PARKINSON'S”.
IF HEST.OCEMPHYS = 1/Yes in any round, display
“EMPHYSEMA/ASTHMA/COPD”.
IF HEST.OCPPARAL = 1/Yes in any round, display “PARALYSIS”.
IF HEST.OCAMPUTE = 1/Yes in any round, display “LOSS OF
LIMB”.
IF HEST.OCBETES = 1/Yes in any round, display “DIABETES”.

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

You told me that [you have/(SP) has] had [READ CONDITIONS
LISTED BELOW]. (Was this/Were any of these) the original cause
of [your/(SP's)] becoming eligible for Medicare?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:48 PM Thursday, March 28, 2013

Page 339 of 789

HFJ42

Field1:

EMCOND

Cheshire Name:

( HFQ3100 )

HEST.EMCOND

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ28 - (HFQ3160 )

English text: YES
No

HFJ43 - EMCAUSEVB ( HFQ3110 )

English text: NO
Attribute

Route

Don't know

BOX HFP0 - (HFQ3175 )

Refusal

BOX HFP0 - (HFQ3175 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
SP responded “YES” to only one HFJ Condition in any round where

HEST.HESTRND < = current round=

Only one of the following fields = 1/Yes in any round where

HEST.HESTRND < = current round:

HEST.OCARTERY = 1/Yes in any round, or

HEST.OCHBP = 1/Yes in any round, or

4:17:49 PM Thursday, March 28, 2013

Page 340 of 789

HFJ42
HEST.OCMYOCAR = 1/Yes in any round, or
HEST.OCCHD = 1/Yes in any round, or
HEST.OCCFAIL = 1/Yes in any round, or
HEST.OCCVALVE = 1/Yes in any round, or
HEST.OCRHYTHM = 1/Yes in any round, or
HEST.OCOTHHRT = 1/Yes in any round, or
HEST.OCSTROKE = 1/Yes in any round, or
HEST.OCCSKIN = 1/Yes in any round, or
HEST.OCCANCER = 1/Yes in any round, or
HEST.OCARTHRH = 1/Yes in any round, or
HEST.OCARTH = 1/Yes in any round, or
HEST.OCMENTAL = 1/Yes in any round, or
HEST.OCALZMER = 1/Yes in any round, or
HEST.OCDEMENT = 1/Yes in any round, or
HEST.OCDEPRSS = 1/Yes in any round, or
HEST.OCPSYCHO = 1/Yes in any round, or
HEST.OCOSTEOP = 1/Yes in any round, or
HEST.OCBRKHIP = 1/Yes in any round, or
HEST.OCPARKIN = 1/Yes in any round, or
HEST.OCEMPHYS = 1/Yes in any round, or
HEST.OCPPARAL = 1/Yes in any round, or
HEST.OCAMPUTE = 1/Yes in any round, or
HEST.OCBETES = 1/Yes in any round.
NOTE: We do not include a check for HEST.OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.

4:17:49 PM Thursday, March 28, 2013

Page 341 of 789

HFJ43

HFJ43

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 1:

EMCAUSEVB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1720

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

What was the original cause of [your/(SP's)] becoming eligible for
Medicare?

Int. Instr II:

RECORD VERBATIM.

INPUT FIELDS / ROUTING

4:17:49 PM Thursday, March 28, 2013

Page 342 of 789

HFJ43

Field1:
Cheshire Name:

EMCAUSEVB

( HFQ3110 )

NONE
REPLACES CHESHIRE VARIABLES:
HEST.EMCAUSE1
HEST.EMCAUSE2
HEST.EMCAUSE3
DATA EDITING CODING VARIABLES:
HEST.EMCAUSC1
HEST.EMCAUSC2

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Open
TOpen135
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

135

Route
BOX HFP0 - (HFQ3175 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:50 PM Thursday, March 28, 2013

Page 343 of 789

BOX HFJ28

BOX HFJ28

Page Order # :

1730

BOX INSTRUCTIONS
( HFQ3160 )

IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO BOX
HFP0 - (HFQ3175 ).
ELSE GO TO HFJ44 - EMCODE ( HFQ3165 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES
SP responded “YES” to only one HFJ Condition in any round where
HEST.HESTRND < = current round =
Only one of the following fields = 1/Yes in any round where
HEST.HESTRND < = current round:
HEST.OCARTERY = 1/Yes in any round, or
HEST.OCHBP = 1/Yes in any round, or
HEST.OCMYOCAR = 1/Yes in any round, or
HEST.OCCHD = 1/Yes in any round, or
HEST.OCCFAIL = 1/Yes in any round, or
HEST.OCCVALVE = 1/Yes in any round, or
HEST.OCRHYTHM = 1/Yes in any round, or
HEST.OCOTHHRT = 1/Yes in any round, or
HEST.OCSTROKE = 1/Yes in any round, or
HEST.OCCSKIN = 1/Yes in any round, or
HEST.OCCANCER = 1/Yes in any round, or
HEST.OCARTHRH = 1/Yes in any round, or
HEST.OCARTH = 1/Yes in any round, or
HEST.OCMENTAL = 1/Yes in any round, or
HEST.OCALZMER = 1/Yes in any round, or
HEST.OCDEMENT = 1/Yes in any round, or
HEST.OCDEPRSS = 1/Yes in any round, or
HEST.OCPSYCHO = 1/Yes in any round, or
HEST.OCOSTEOP = 1/Yes in any round, or
HEST.OCBRKHIP = 1/Yes in any round, or
HEST.OCPARKIN = 1/Yes in any round, or
HEST.OCEMPHYS = 1/Yes in any round, or
HEST.OCPPARAL = 1/Yes in any round, or
HEST.OCAMPUTE = 1/Yes in any round, or
HEST.OCBETES = 1/Yes in any round.
NOTE: We do not include a check for HEST.OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.

4:17:50 PM Thursday, March 28, 2013

Page 344 of 789

HFJ44

HFJ44

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

EMCODE

Field 2:

EMOS

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

1740

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Which of these conditions was the cause of [your/(SP's)] becoming

eligible for Medicare?
[PROBE: Any other condition?]

Int. Instr II:

CHECK UP TO 8 CONDITIONS.

INPUT FIELDS / ROUTING

4:17:51 PM Thursday, March 28, 2013

Page 345 of 789

HFJ44

4:17:54 PM Thursday, March 28, 2013

Page 346 of 789

HFJ44

Field1:
Cheshire Name:

EMCODE

( HFQ3165 )

NONE
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=HEST.EMARTERY
2=HEST.EMHBP
3=HEST.EMMYOCAR
4=HEST.EMCHD
5=HEST.EMCFAIL
6=HEST.EMCVALVE
7=HEST.EMRHYTHM
8=HEST.EMOTHHRT
9=HEST.EMSTROKE
10=HEST.EMCSKIN
11=HEST.EMCANCER
12=HEST.EMARTHRH
13=HEST.EMARTH
14=HEST.EMMENTAL
15=HEST.EMALZMER
16=HEST.EMDEMENT
17=HEST.EMDEPRSS
18=HEST.EMPSYCHO
19=HEST.EMOSTEOP
20=HEST.EMBRKHIP
21=HEST.EMPARKIN
22=HEST.EMEMPHYS
23=HEST.EMPPARAL
24=HEST.EMAMPUTE
25=HEST.EMDIABTS
91=HEST.EMOTHOS

Item Text display:

If response to HFJ CONDITION = 1/Yes in any round,
where HEST.HESTRND < = current round, display
condition as a response option at HFJ44 - EMCODE.
Else do not display response option.
If HEST.OCARTERY = 1/Yes in any round, display HFJ44
– EMCODE response option 1.
Else do not display.
IF HEST.OCHBP = 1/Yes in any round, display HFJ44 –

EMCODE response option 2.

Else do not display.

IF HEST.OCMYOCAR = 1/Yes in any round, display

HFJ44 – EMCODE response option 3.

Else do not display.

IF HEST.OCCHD = 1/Yes in any round, display HFJ44 –

EMCODE response option 4.

Else do not display.

IF HEST.OCCFAIL = 1/Yes in any round, display HFJ44 –

EMCODE response option 5.

Else do not display.

IF HEST.OCCVALVE = 1/Yes in any round, display HFJ44

4:17:57 PM Thursday, March 28, 2013

Page 347 of 789

HFJ44
– EMCODE response option 6.
Else do not display.
IF HEST.OCRHYTHM = 1/Yes in any round, display HFJ44
– EMCODE response option 7.
Else do not display.
IF HEST.OCOTHHRT = 1/Yes in any round, display HFJ44
– EMCODE response option 8.
Else do not display.
IF HEST.OCSTROKE = 1/Yes in any round, display HFJ44
– EMCODE response option 9.
Else do not display.
IF HEST.OCCSKIN = 1/Yes in any round, display HFJ44 –

EMCODE response option 10.

Else do not display.

IF HEST.OCCANCER = 1/Yes in any round, display HFJ44
– EMCODE response option 11.
Else do not display.
IF HEST.OCARTHRH = 1/Yes in any round, display HFJ44
– EMCODE response option 12.
Else do not display.
IF HEST.OCARTH = 1/Yes in any round, display HFJ44 –

EMCODE response option 13.

Else do not display.

IF HEST.OCMENTAL = 1/Yes in any round, display HFJ44
– EMCODE response option 14.
Else do not display.
IF HEST.OCALZMER = 1/Yes in any round, display HFJ44
– EMCODE response option 15.
Else do not display.
IF HEST.OCDEMENT = 1/Yes in any round, display HFJ44
– EMCODE response option 16.
Else do not display.
IF HEST.OCDEPRSS = 1/Yes in any round, display HFJ44
– EMCODE response option 17.
Else do not display.
IF HEST.OCPSYCHO = 1/Yes in any round, display HFJ44
– EMCODE response option 18.
Else do not display.
IF HEST.OCOSTEOP = 1/Yes in any round, display HFJ44
– EMCODE response option 19.
Else do not display.
IF HEST.OCBRKHIP = 1/Yes in any round, display HFJ44
– EMCODE response option 20.
Else do not display.
IF HEST.OCPARKIN = 1/Yes in any round, display HFJ44
– EMCODE response option 21.
4:17:59 PM Thursday, March 28, 2013

Page 348 of 789

HFJ44
Else do not display.
IF HEST.OCEMPHYS = 1/Yes in any round, display HFJ44
– EMCODE response option 22.
Else do not display.
IF HEST.OCPPARAL = 1/Yes in any round, display HFJ44
– EMCODE response option 23.
Else do not display.
IF HEST.OCAMPUTE = 1/Yes in any round, display HFJ44
– EMCODE response option 24.
Else do not display.
IF HEST.OCBETES = 1/Yes in any round, display HFJ44 –

EMCODE response option 25.

Else do not display.

Always display HFJ – EMCODE response option 91.

Item Text:

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TEMCode
8
No
No

Number Label
1 AteriesHardening

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP0 - (HFQ3175 )

2

English text: ARTERIES HARDENING
Hypertension

BOX HFP0 - (HFQ3175 )

3

English text: HYPERTENSION
HeartAttack

BOX HFP0 - (HFQ3175 )

4

English text: HEART ATTACK
HeartDisease

BOX HFP0 - (HFQ3175 )

5

English text: HEART DISEASE
CongestiveHeartFailure

BOX HFP0 - (HFQ3175 )

6

English text: CONGESTIVE HEART FAILURE
HeartValveProblem
BOX HFP0 - (HFQ3175 )

7

English text: HEART VALVE PROBLEM
HeartRhythmProblem

BOX HFP0 - (HFQ3175 )

8

English text: HEART RHYTHM PROBLEM
OtherHeartProblem

BOX HFP0 - (HFQ3175 )

9

English text: OTHER HEART PROBLEM
StrokeOrHemorrhage

BOX HFP0 - (HFQ3175 )

English text: STROKE OR HEMORRHAGE
4:18:02 PM Thursday, March 28, 2013

Page 349 of 789

HFJ44

10

SkinCancer

BOX HFP0 - (HFQ3175 )

11

English text: SKIN CANCER
CancerTumor

BOX HFP0 - (HFQ3175 )

12

English text: CANCER/TUMOR
RheumatioidArthritis

BOX HFP0 - (HFQ3175 )

13

English text: RHEUMATOID ARTHRITIS
OtherArthritis

BOX HFP0 - (HFQ3175 )

14

English text: OTHER ARTHRITIS
MentalRetardation

BOX HFP0 - (HFQ3175 )

15

English text: MENTAL RETARDATION
Alzheimers

BOX HFP0 - (HFQ3175 )

16

English text: ALZHEIMER'S
Dementia

BOX HFP0 - (HFQ3175 )

17

English text: DEMENTIA
Depression

BOX HFP0 - (HFQ3175 )

18

English text: DEPRESSION
MentalDisorder

BOX HFP0 - (HFQ3175 )

19

English text: MENTAL DISORDER
Osteoporosis

BOX HFP0 - (HFQ3175 )

20

English text: OSTEOPOROSIS
BrokenHip

BOX HFP0 - (HFQ3175 )

21

English text: BROKEN HIP
Parkinsons

BOX HFP0 - (HFQ3175 )

22

English text: PARKINSON'S
EmphysemaAsthmaCOPD

BOX HFP0 - (HFQ3175 )

23

English text: EMPHYSEMA/ASTHMA/COPD
Paralysis
BOX HFP0 - (HFQ3175 )

24

English text: PARALYSIS
LossOfLimb

BOX HFP0 - (HFQ3175 )

25

English text: LOSS OF LIMB
Diabetes

BOX HFP0 - (HFQ3175 )

91

English text: DIABETES
Other

HFJ44 - EMOS ( HFQ3166 )

English text: OTHER
Attribute
Don't know

Route
BOX HFP0 - (HFQ3175 )

Refusal

BOX HFP0 - (HFQ3175 )

4:18:05 PM Thursday, March 28, 2013

Page 350 of 789

HFJ44

Field2:
Cheshire Name:

EMOS

( HFQ3166 )

HEST.EMOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFP0 - (HFQ3175 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1
If response to HFJ44 - EMCODE only includes 91/Other, display
message "PROBE WHETHER PREVIOUSLY ENTERED
CONDITION WAS CAUSE FOR ELIGIBILITY. REENTER OR
SELECT PREVIOUS PAGE TO CORRECT".
HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:06 PM Thursday, March 28, 2013

Page 351 of 789

BOX HFP0

BOX HFP0

Page Order # :

1750

BOX INSTRUCTIONS
( HFQ3175 )

IF THIS IS ROUND 67, GO TO BOX HFR1 - (HFQ3397 ).
ELSE GO TO HFPINTRO - HLTHCAREINTRO ( HFQ3182 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:18:06 PM Thursday, March 28, 2013

Page 352 of 789

HFPINTRO

HFPINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

HLTHCAREINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1760

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now I want to ask you about some things that [you/(SP)] may be
doing to maintain (your/his/her) health, either by getting tested for
health problems or by taking care of conditions that (you have/she
has/he has).

Int. Instr II:
INPUT FIELDS / ROUTING

4:18:07 PM Thursday, March 28, 2013

Page 353 of 789

HFPINTRO

Field1:

HLTHCAREINTRO

Cheshire Name:

( HFQ3182 )

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 HFP1A - (HFQ3186 )

English text: CONTINUE
Attribute

Route

Empty

BOX HFP1A - (HFQ3186 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:07 PM Thursday, March 28, 2013

Page 354 of 789

BOX HFP1A

BOX HFP1A

Page Order # :

1765

BOX INSTRUCTIONS
( HFQ3186 )

IF (HFJ41A – OCBETES = 1/Yes) AND (HFJ41B - OCDTYPE = 1/TypeOne,
2/TypeTwo, 3/Borderline, 4/PreDiabetes, 91/Other, DK, or RF), GO TO HFP1 ­
DIAAGE ( HFQ3189 ).
ELSE GO TO HFP21 - DIAEVERT ( HFQ3379 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:18:08 PM Thursday, March 28, 2013

Page 355 of 789

HFP1

HFP1

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIAAGE

Field 2:

DIAAGE_LESSONE

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1770

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFJ41B - OCDTYPE = 1/TypeOne, display "Type 1 diabetes".
Else if HFJ41B - OCDTYPE = 2/TypeTwo, display "Type 2
diabetes".
Else if HFJ41B - OCDTYPE = 3/Borderline, display "borderline
diabetes".
Else if HFJ41B - OCDTYPE = 4/PreDiabetes, display "pre­
diabetes".
Else display "diabetes".

Multi Field display:

Vertical Alignment
Display all input fields at one time.

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:18:09 PM Thursday, March 28, 2013

I recorded that [you were/(SP) was] told by a doctor that (you

have/she has/he has) (Type 1 diabetes/Type 2 diabetes/borderline
Page 356 of 789

HFP1
diabetes/pre-diabetes/diabetes).
How old [were you/was (SP)] when (you were/he was/she was) first
told that (you/he/she) had diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

DIAAGE

Cheshire Name:

( HFQ3189 )

HEST.DIAAGE

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

AGE:
Left

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

Integer
TDiaage
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Empty

HFP1 - DIAAGE_LESSONE ( HFQ3192 )

Don't know

HFP1 - DIAAGE_LESSONE ( HFQ3192 )

Refusal

HFP1 - DIAAGE_LESSONE ( HFQ3192 )

4:18:11 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

1
997

Route
HFP1 - DIAAGE_LESSONE ( HFQ3192 )

Page 357 of 789

HFP1

Field2:

DIAAGE_LESSONE

Cheshire Name:

( HFQ3192 )

NONE
REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.DIAAGE_LESSONE = 1/LessThanOneYearOld, set

HEST.DIAAGE = 996.

Else if HEST.DIAAGE_LESSONE = 2/NeverToldDiabetes, set

HEST.DIAAGE = 997.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TDiage9967
1
No
No

Number Label
1 LessThanOneYearOld
2

English text: LESS THAN ONE YEAR OLD
NeverToldDiabetes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP2 - (HFQ3198 )
HFP21 - DIAEVERT ( HFQ3379 )

English text: SP WAS NEVER TOLD HE/SHE HAS DIABETES
Attribute

Route

Empty

BOX HFP2 - (HFQ3198 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1:

HFP1 - DIAAGE and HFP1 - DIAAGE_LESSONE cannot both be

EMPTY.

If not true, display message "PLEASE ENTER AGE OR SELECT

"LESS THAN ONE YEAR OLD". ".

Edit #2:

HFP1 - DIAAGE and HFP1 - DIAAGE_LESSONE cannot both be

FILLED.

If not true, display message "PLEASE ENTER AGE OR SELECT

4:18:13 PM Thursday, March 28, 2013

Page 358 of 789

HFP1
"LESS THAN ONE YEAR OLD". ".
Edit #3:

HFP1 - DIAAGE = 1 - 100, DK, RF, or EMPTY.

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

RANGE. PLEASE REENTER.".

TECHNICAL NOTES

DESIGN NOTES

4:18:13 PM Thursday, March 28, 2013

Page 359 of 789

BOX HFP2

BOX HFP2

Page Order # :

1775

BOX INSTRUCTIONS
( HFQ3198 )

IF THE SP IS FEMALE AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR
(HFP1 – DIAAGE = DK OR RF), GO TO HFP2 - DIAPRGNT ( HFQ3199 ).
ELSE GO TO HFP4 - DIAINSUL ( HFQ3202 ).

ASSIGNMENTS

TECHNICAL NOTES
5

SPMale

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:18:13 PM Thursday, March 28, 2013

Page 360 of 789

HFP2

HFP2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAPRGNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1780

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Did [you/(SP)] have diabetes only during a pregnancy?

Int. Instr II:

INPUT FIELDS / ROUTING

4:18:13 PM Thursday, March 28, 2013

Page 361 of 789

HFP2

Field1:

DIAPRGNT

Cheshire Name:

( HFQ3199 )

HEST.DIAPRGNT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP21 - DIAEVERT ( HFQ3379 )

English text: YES
No

HFP4 - DIAINSUL ( HFQ3202 )

English text: NO
Attribute

Route

Don't know

HFP21 - DIAEVERT ( HFQ3379 )

Refusal

HFP21 - DIAEVERT ( HFQ3379 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:14 PM Thursday, March 28, 2013

Page 362 of 789

HFP4

HFP4

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

DIAINSUL

Field 2:

DIAMEDS

Field 3:

DIATEST

Field 4:

DIASORES

Field 5:

DIAPRESS

Field 6:

DIAASPRN

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1785

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

4:18:16 PM Thursday, March 28, 2013

Please tell me whether (you use/SP uses) any of the following ways
to manage (your/his/her) diabetes. [Do you/Does (SP)]…

Page 363 of 789

HFP4
Int. Instr II:

INPUT FIELDS / ROUTING

DIAINSUL

Field1:
Cheshire Name:

( HFQ3202 )

HEST.DIAINSUL

Item Text display:

Display "a." in front of LIST item text.

Item Text:

take insulin?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP4 - DIAMEDS ( HFQ3206 )

English text: YES
No

HFP4 - DIAMEDS ( HFQ3206 )

English text: NO
Attribute

Route

Don't know

HFP4 - DIAMEDS ( HFQ3206 )

Refusal

HFP4 - DIAMEDS ( HFQ3206 )

4:18:18 PM Thursday, March 28, 2013

Page 364 of 789

HFP4

Field2:

DIAMEDS

Cheshire Name:

( HFQ3206 )

HEST.DIAMEDS

Item Text display:

Display "b." in front of LIST item text.

Item Text:

take prescription diabetes pills or oral diabetes medicine?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP4 - DIATEST ( HFQ3209 )

English text: YES
No

HFP4 - DIATEST ( HFQ3209 )

English text: NO
Attribute

Route

Don't know

HFP4 - DIATEST ( HFQ3209 )

Refusal

HFP4 - DIATEST ( HFQ3209 )

4:18:21 PM Thursday, March 28, 2013

Page 365 of 789

HFP4

Field3:

DIATEST

Cheshire Name:

( HFQ3209 )

HEST.DIATEST

Item Text display:

Display "c." in front of LIST item text.

Item Text:

test (your/his/her) blood for sugar or glucose?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP4 - DIASORES ( HFQ3219 )

English text: YES
No

HFP4 - DIASORES ( HFQ3219 )

English text: NO
Attribute

Route

Don't know

HFP4 - DIASORES ( HFQ3219 )

Refusal

HFP4 - DIASORES ( HFQ3219 )

4:18:23 PM Thursday, March 28, 2013

Page 366 of 789

HFP4

Field4:

DIASORES

Cheshire Name:

( HFQ3219 )

HEST.DIASORES

Item Text display:

Display "f." in front of LIST item text.

Item Text:

check for sores or irritations on (your/his/her) feet?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP4 - DIAPRESS ( HFQ3226 )

English text: YES
No

HFP4 - DIAPRESS ( HFQ3226 )

English text: NO
Attribute

Route

Don't know

HFP4 - DIAPRESS ( HFQ3226 )

Refusal

HFP4 - DIAPRESS ( HFQ3226 )

4:18:26 PM Thursday, March 28, 2013

Page 367 of 789

HFP4

Field5:

DIAPRESS

Cheshire Name:

( HFQ3226 )

HEST.DIAPRESS

Item Text display:

Display "h." in front of LIST item text.

Item Text:

measure (your/his/her) blood pressure at home?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP4 - DIAASPRN ( HFQ3228 )

English text: YES
No

HFP4 - DIAASPRN ( HFQ3228 )

English text: NO
Attribute

Route

Don't know

HFP4 - DIAASPRN ( HFQ3228 )

Refusal

HFP4 - DIAASPRN ( HFQ3228 )

4:18:29 PM Thursday, March 28, 2013

Page 368 of 789

HFP4

Field6:

DIAASPRN

Cheshire Name:

( HFQ3228 )

HEST.DIAASPRN

Item Text display:

Display "i." in front of LIST item text.

Item Text:

take aspirin regularly for (your/his/her) diabetes?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP3 - (HFQ3229 )

English text: YES
No

BOX HFP3 - (HFQ3229 )

English text: NO
Attribute

Route

Don't know

BOX HFP3 - (HFQ3229 )

Refusal

BOX HFP3 - (HFQ3229 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:30 PM Thursday, March 28, 2013

Page 369 of 789

BOX HFP3

BOX HFP3

Page Order # :

1790

BOX INSTRUCTIONS
( HFQ3229 )

IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE ( HFQ3232 ).
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE ( HFQ3246 ).
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282
).
ELSE GO TO HFP10 - DIATENYR ( HFQ3294 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:18:30 PM Thursday, March 28, 2013

Page 370 of 789

HFP5

HFP5

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

INSUTAKE

Field 2:

INSUDAY

Field 3:

INSUWEEK

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1795

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Vertical Alignment

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

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

How often [do you/does (SP)] take insulin?

Int. Instr II:
INPUT FIELDS / ROUTING

4:18:31 PM Thursday, March 28, 2013

Page 371 of 789

HFP5

Field1:

INSUTAKE

Cheshire Name:

( HFQ3232 )

HEST.INSUTAKE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TInsutak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP5 - INSUDAY ( HFQ3236 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
UseInsulinPump
BOX HFP4 - (HFQ3242 )

HFP5 - INSUWEEK ( HFQ3239 )

English text: USE INSULIN PUMP
Attribute
Don't know

Route
BOX HFP4 - (HFQ3242 )

Refusal

BOX HFP4 - (HFQ3242 )

4:18:33 PM Thursday, March 28, 2013

Page 372 of 789

HFP5

Field2:
Cheshire Name:

INSUDAY

( HFQ3236 )

HEST.INSUDAY

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

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:
Cheshire Name:

INSUWEEK

1
100

Route
BOX HFP4 - (HFQ3242 )
( HFQ3239 )

HEST.INSUWEEK

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES PER W EEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
THFW eek
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP4 - (HFQ3242 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:
4:18:34 PM Thursday, March 28, 2013

Page 373 of 789

HFP5
HFP5 - INSUDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY SEEMS

UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP5 - INSUW EEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:34 PM Thursday, March 28, 2013

Page 374 of 789

BOX HFP4

BOX HFP4

Page Order # :

1800

BOX INSTRUCTIONS
( HFQ3242 )

IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE ( HFQ3246 ).
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282
).
ELSE GO TO HFP10 - DIATENYR ( HFQ3294 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:18:34 PM Thursday, March 28, 2013

Page 375 of 789

HFP6

HFP6

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

MEDSTAKE

Field 2:

MEDDAY

Field 3:

MEDWEEK

Field 4:

MEDMONTH

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1805

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Vertical Alignment

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

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

How often [do you/does (SP)] take prescription diabetes pills or oral
diabetes medicine?

Int. Instr II:
INPUT FIELDS / ROUTING
4:18:35 PM Thursday, March 28, 2013

Page 376 of 789

HFP6

Field1:

MEDSTAKE

Cheshire Name:

( HFQ3246 )

HEST.MEDSTAKE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TMedstak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP6 - MEDDAY ( HFQ3249 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP6 - MEDMONTH ( HFQ3256 )

HFP6 - MEDWEEK ( HFQ3252 )

English text: NUMBER OF TIMES PER MONTH
Attribute
Don't know

Route
BOX HFP5 - (HFQ3259 )

Refusal

BOX HFP5 - (HFQ3259 )

4:18:37 PM Thursday, March 28, 2013

Page 377 of 789

HFP6

Field2:
Cheshire Name:

MEDDAY

( HFQ3249 )

HEST.MEDDAY

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

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:
Cheshire Name:

MEDWEEK

1
100

Route
BOX HFP5 - (HFQ3259 )
( HFQ3252 )

HEST.MEDWEEK

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES PER W EEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
THFW eek
1
No
No

Number Label
1 [Continuous answer.]

4:18:39 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP5 - (HFQ3259 )

Page 378 of 789

HFP6

Field4:
Cheshire Name:

MEDMONTH

( HFQ3256 )

HEST.MEDMONTH

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

NUMBER OF TIMES PER MONTH:
Left

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

Integer
THFMonth
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP5 - (HFQ3259 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

HFP6 - MEDDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY SEEMS

UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP6 - MEDW EEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #3:

HFP6 - MEDMONTH = 1 - 500.

If not true, display message "NUMBER OF TIMES PER MONTH

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:40 PM Thursday, March 28, 2013

Page 379 of 789

BOX HFP5

BOX HFP5

Page Order # :

1810

BOX INSTRUCTIONS
( HFQ3259 )

IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK (
HFQ3282 ).
ELSE GO TO HFP10 - DIATENYR ( HFQ3294 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:18:40 PM Thursday, March 28, 2013

Page 380 of 789

HFP7

HFP7

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

TESTTAKE

Field 2:

TESTDAY

Field 3:

TESTWEEK

Field 4:

TESTMNTH

Field 5:

TESTYEAR

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1815

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

How often [do you/does (SP)] test (your/his/her) blood for sugar or

glucose?
[PROBE: Include times when it is tested by a family member or
friend, but do not include times when it is tested by a health

4:18:41 PM Thursday, March 28, 2013

Page 381 of 789

HFP7
professional.]
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

TESTTAKE

Cheshire Name:

( HFQ3262 )

HEST.TESTTAKE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTesttak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP7 - TESTDAY ( HFQ3266 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP7 - TESTMNTH ( HFQ3272 )

4

English text: NUMBER OF TIMES PER MONTH
NumberPerYear
HFP7 - TESTYEAR ( HFQ3276 )

HFP7 - TESTWEEK ( HFQ3269 )

English text: NUMBER OF TIMES PER YEAR
Attribute

Route

Don't know

BOX HFP6 - (HFQ3279 )

Refusal

BOX HFP6 - (HFQ3279 )

4:18:43 PM Thursday, March 28, 2013

Page 382 of 789

HFP7

Field2:
Cheshire Name:

TESTDAY

( HFQ3266 )

HEST.TESTDAY

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

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:
Cheshire Name:

TESTWEEK

1
100

Route
BOX HFP6 - (HFQ3279 )
( HFQ3269 )

HEST.TESTWEEK

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES PER W EEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
THFW eek
1
No
No

Number Label
1 [Continuous answer.]

4:18:44 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP6 - (HFQ3279 )

Page 383 of 789

HFP7

Field4:
Cheshire Name:

TESTMNTH

( HFQ3272 )

HEST.TESTMONTH

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

NUMBER OF TIMES PER MONTH:
Left

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

Integer
THFMonth

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field5:
Cheshire Name:

TESTYEAR

1
1000

Route
BOX HFP6 - (HFQ3279 )
( HFQ3276 )

HEST.TESTYEAR

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES PER YEAR:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
THFYear
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
10000

Route
BOX HFP6 - (HFQ3279 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:
4:18:46 PM Thursday, March 28, 2013

Page 384 of 789

HFP7
HFP7 - TESTDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY SEEMS

UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP7 - TESTW EEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #3:

HFP7 - TESTMNTH = 1 - 500.

If not true, display message "NUMBER OF TIMES PER MONTH

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #4:

HFP7 - TESTYEAR = 1 - 5000.

If not true, display message "NUMBER OF TIMES PER YEAR

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:46 PM Thursday, March 28, 2013

Page 385 of 789

BOX HFP6

BOX HFP6

Page Order # :

1820

BOX INSTRUCTIONS
( HFQ3279 )

IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282 ).
ELSE GO TO HFP10 - DIATENYR ( HFQ3294 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:18:46 PM Thursday, March 28, 2013

Page 386 of 789

HFP8

HFP8

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

SORECHEK

Field 2:

SOREDAY

Field 3:

SOREWEEK

Field 4:

SOREMNTH

Field 5:

SOREYEAR

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1825

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Vertical Alignment

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

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

How often [do you/does (SP)] check (your/his/her) feet for sores or
irritations?
[PROBE: Include times when they are checked by a family member
or friend, but do not include times when they are checked by a health

4:18:47 PM Thursday, March 28, 2013

Page 387 of 789

HFP8
professional.]
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

SORECHEK

Cheshire Name:

( HFQ3282 )

HEST.SORECHEK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTesttak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP8 - SOREDAY ( HFQ3286 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP8 - SOREMNTH ( HFQ3290 )

4

English text: NUMBER OF TIMES PER MONTH
NumberPerYear
HFP8 - SOREYEAR ( HFQ3292 )

HFP8 - SOREWEEK ( HFQ3288 )

English text: NUMBER OF TIMES PER YEAR
Attribute

Route

Don't know

HFP10 - DIATENYR ( HFQ3294 )

Refusal

HFP10 - DIATENYR ( HFQ3294 )

4:18:49 PM Thursday, March 28, 2013

Page 388 of 789

HFP8

Field2:
Cheshire Name:

SOREDAY

( HFQ3286 )

HEST.SOREDAY

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

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:
Cheshire Name:

SOREWEEK

1
100

Route
HFP10 - DIATENYR ( HFQ3294 )
( HFQ3288 )

HEST.SOREWEEK

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES PER W EEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
THFW eek
1
No
No

Number Label
1 [Continuous answer.]

4:18:51 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
HFP10 - DIATENYR ( HFQ3294 )

Page 389 of 789

HFP8

Field4:
Cheshire Name:

SOREMNTH

( HFQ3290 )

HEST.SOREMNTH

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

NUMBER OF TIMES PER MONTH:
Left

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

Integer
THFMonth

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field5:
Cheshire Name:

SOREYEAR

1
1000

Route
HFP10 - DIATENYR ( HFQ3294 )
( HFQ3292 )

HEST.SOREYEAR

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES PER YEAR:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
THFYear
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
10000

Route
HFP10 - DIATENYR ( HFQ3294 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:
4:18:52 PM Thursday, March 28, 2013

Page 390 of 789

HFP8
HFP8 - SOREDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY SEEMS

UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP8 - SOREWEEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #3:

HFP8 - SOREMNTH = 1 - 500.

If not true, display message "NUMBER OF TIMES PER MONTH

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #4:

HFP8 - SOREYEAR = 1 - 5000.

If not true, display message "NUMBER OF TIMES PER YEAR

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:52 PM Thursday, March 28, 2013

Page 391 of 789

HFP10

HFP10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIATENYR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1830

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

In the past year has a doctor or other medical professional examined
(your/his/her) feet for sores or irritations?

Int. Instr II:
INPUT FIELDS / ROUTING

4:18:53 PM Thursday, March 28, 2013

Page 392 of 789

HFP10

Field1:

DIATENYR

Cheshire Name:

( HFQ3294 )

HEST.DIATENYR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP11 - DIADRSAW ( HFQ3296 )

English text: YES
No

HFP11 - DIADRSAW ( HFQ3296 )

English text: NO
Attribute

Route

Don't know

HFP11 - DIADRSAW ( HFQ3296 )

Refusal

HFP11 - DIADRSAW ( HFQ3296 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:54 PM Thursday, March 28, 2013

Page 393 of 789

HFP11

HFP11

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIADRSAW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1835

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

About how many times in the past year [have you/has (SP)] seen a
doctor or other health professional for (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:18:55 PM Thursday, March 28, 2013

Page 394 of 789

HFP11

Field1:

DIADRSAW

Cheshire Name:

( HFQ3296 )

HEST.DIADRSAW

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

NUMBER OF TIMES:
Left

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

Integer
TDiadrsaw
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFP13 - DIAHEMOC ( HFQ3298 )

Refusal

HFP13 - DIAHEMOC ( HFQ3298 )

FieldSize:

Min Value:
Max Value:
Mask:

0

200

Route
HFP13 - DIAHEMOC ( HFQ3298 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

HFP11 - DIADRSAW = 1 - 100.

If not true, display message "NUMBER OF TIMES SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:55 PM Thursday, March 28, 2013

Page 395 of 789

HFP13

HFP13

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIAHEMOC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1838

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

A test of hemoglobin "A one C" measures the average level of blood
sugar over the past three months. It is usually done in a doctor's
office. About how many times in the past year has a doctor or other
health professional checked [you/(SP)] for hemoglobin "A one C"?

Int. Instr II:
INPUT FIELDS / ROUTING

4:18:56 PM Thursday, March 28, 2013

Page 396 of 789

HFP13

Field1:

DIAHEMOC

Cheshire Name:

( HFQ3298 )

HEST.DIAHEMOC

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

NUMBER OF TIMES:
Left

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

Integer
TDiahemo
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFP14 - DIACTRLD ( HFQ3300 )

Refusal

HFP14 - DIACTRLD ( HFQ3300 )

FieldSize:

Min Value:
Max Value:
Mask:

0

200

Route
HFP14 - DIACTRLD ( HFQ3300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

HFP13 - DIAHEMOC = 1 - 100.

If not true, display message "NUMBER OF TIMES SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:18:57 PM Thursday, March 28, 2013

Page 397 of 789

HFP14

HFP14

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIACTRLD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1841

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF4

Question Text:

Would you say that [your/(SP's)] blood sugar is well controlled all of
the time, most of the time, some of the time, a little of the time, or
none of the time? By "well controlled" we mean a recent hemoglobin
"A one C" result of 7.5 or less or an average fasting blood test of 140
or less.

Int. Instr II:

INPUT FIELDS / ROUTING

4:18:58 PM Thursday, March 28, 2013

Page 398 of 789

HFP14

Field1:

DIACTRLD

Cheshire Name:

( HFQ3300 )

HEST.DIACTRLD

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiactrl
1
No
No

Number Label
1 AllOfTheTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP14A1 - DIAHYPO ( HFQ3302 )

2

English text: ALL OF THE TIME
MostOfTheTime

HFP14A1 - DIAHYPO ( HFQ3302 )

3

English text: MOST OF THE TIME
SomeOfTheTime

HFP14A1 - DIAHYPO ( HFQ3302 )

4

English text: SOME OF THE TIME
ALittleOfTheTime

HFP14A1 - DIAHYPO ( HFQ3302 )

5

English text: A LITTLE OF THE TIME
NoneOfTheTime

HFP14A1 - DIAHYPO ( HFQ3302 )

English text: NONE OF THE TIME
Attribute

Route

Don't know

HFP14A1 - DIAHYPO ( HFQ3302 )

Refusal

HFP14A1 - DIAHYPO ( HFQ3302 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:19:00 PM Thursday, March 28, 2013

Page 399 of 789

HFP14
DESIGN NOTES

4:19:00 PM Thursday, March 28, 2013

Page 400 of 789

HFP14A1

HFP14A1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAHYPO

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

1844

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

In the past year, [have you/has (SP)] experienced hypoglycemia,
sometimes called low blood sugar or an insulin reaction?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:00 PM Thursday, March 28, 2013

Page 401 of 789

HFP14A1

Field1:

DIAHYPO

Cheshire Name:

( HFQ3302 )

HEST.DIAHYPO

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
HFP14A2 - DIAHYPTR ( HFQ3304 )

English text: YES
No

HFP14A - DIAFEET ( HFQ3316 )

English text: NO
Attribute

Route

Don't know

HFP14A - DIAFEET ( HFQ3316 )

Refusal

HFP14A - DIAFEET ( HFQ3316 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:01 PM Thursday, March 28, 2013

Page 402 of 789

HFP14A2

HFP14A2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIAHYPTR

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

1847

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Please think about the most serious episode of hypoglycemia that
[you have/(SP)has] experienced in the past year.
[Were you/Was (SP)] able to treat (yourself/himself/herself) by taking
some form of sugar, did (you/he/she) require treatment from others,
or did (you/he/she) require treatment by a hospital?
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being
treated in the emergency room or outpatient department of a
hospital, or being admitted as an inpatient.]

4:19:02 PM Thursday, March 28, 2013

Page 403 of 789

HFP14A2
Int. Instr II:

INPUT FIELDS / ROUTING

DIAHYPTR

Field1:
Cheshire Name:

( HFQ3304 )

HEST.DIAHYPTR

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TDiaHypTr
1
No
No

Number Label
1 SelfTreatment

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP14A3 - DIAFTEVR ( HFQ3309 )

2

English text: SELF TREATMENT
TreatmentOthers

HFP14A3 - DIAFTEVR ( HFQ3309 )

3

English text: TREATMENT FROM OTHERS
TreatmentHosp

HFP14A3 - DIAFTEVR ( HFQ3309 )

English text: HOSPITAL TREATMENT
Attribute

Route

Don't know

HFP14A3 - DIAFTEVR ( HFQ3309 )

Refusal

HFP14A3 - DIAFTEVR ( HFQ3309 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:19:04 PM Thursday, March 28, 2013

Page 404 of 789

HFP14A2

4:19:04 PM Thursday, March 28, 2013

Page 405 of 789

HFP14A3

HFP14A3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAFTEVR

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

1849

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] ever had any problems with (your/his/her) feet
as a result of (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:04 PM Thursday, March 28, 2013

Page 406 of 789

HFP14A3

Field1:

DIAFTEVR

Cheshire Name:

( HFQ3309 )

HEST.DIAFTEVR

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
HFP14A - DIAFEET ( HFQ3316 )

English text: YES
No

HFP15 - DIAEYPRB ( HFQ3330 )

English text: NO
Attribute

Route

Don't know

HFP15 - DIAEYPRB ( HFQ3330 )

Refusal

HFP15 - DIAEYPRB ( HFQ3330 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:06 PM Thursday, March 28, 2013

Page 407 of 789

HFP14A

HFP14A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAFEET

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1855

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] currently have any problems with (your/his/her)
feet as a result of (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:06 PM Thursday, March 28, 2013

Page 408 of 789

HFP14A

Field1:

DIAFEET

Cheshire Name:

( HFQ3316 )

HEST.DIAFEET

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
HFP14B - DIANEURO ( HFQ3319 )

English text: YES
No

HFP14B - DIANEURO ( HFQ3319 )

English text: NO
Attribute

Route

Don't know

HFP14B - DIANEURO ( HFQ3319 )

Refusal

HFP14B - DIANEURO ( HFQ3319 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:07 PM Thursday, March 28, 2013

Page 409 of 789

HFP14B

HFP14B

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

DIANEURO

Field 2:

DIACIRCF

Field 3:

DIAULCER

Field 4:

DIASKINC

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

1857

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

People with diabetes can develop many different foot problems.
Please tell me if [you have/(SP) has] ever been told by a doctor that
(you/he/she) had any of the following problems with (your/his/her)
feet as a result of (your/his/her) diabetes.
[Have you/Has (SP)] ever been told by a doctor that (you/he/she)

4:19:09 PM Thursday, March 28, 2013

Page 410 of 789

HFP14B
had…
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

DIANEURO

Cheshire Name:

( HFQ3319 )

HEST.DIANEURO

Item Text display:

Display "a." in front of LIST item text.

Item Text:

Neuropathy or nerve damage , which may cause pain or
numbness in the feet?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP14B - DIACIRCF ( HFQ3321 )

English text: YES
No

HFP14B - DIACIRCF ( HFQ3321 )

English text: NO
Attribute

Route

Don't know

HFP14B - DIACIRCF ( HFQ3321 )

Refusal

HFP14B - DIACIRCF ( HFQ3321 )

4:19:11 PM Thursday, March 28, 2013

Page 411 of 789

HFP14B

Field2:

DIACIRCF

Cheshire Name:

( HFQ3321 )

HEST.DIACIRCF

Item Text display:

Display "b." in front of LIST item text.

Item Text:

Poor circulation or blood flow in the feet?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP14B - DIAULCER ( HFQ3324 )

English text: YES
No

HFP14B - DIAULCER ( HFQ3324 )

English text: NO
Attribute

Route

Don't know

HFP14B - DIAULCER ( HFQ3324 )

Refusal

HFP14B - DIAULCER ( HFQ3324 )

4:19:14 PM Thursday, March 28, 2013

Page 412 of 789

HFP14B

Field3:

DIAULCER

Cheshire Name:

( HFQ3324 )

HEST.DIAULCER

Item Text display:

Display "c." in front of LIST item text.

Item Text:

Foot ulcers?

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
HFP14B - DIASKINC ( HFQ3327 )

English text: YES
No

HFP14B - DIASKINC ( HFQ3327 )

English text: NO
Attribute

Route

Don't know

HFP14B - DIASKINC ( HFQ3327 )

Refusal

HFP14B - DIASKINC ( HFQ3327 )

4:19:16 PM Thursday, March 28, 2013

Page 413 of 789

HFP14B

Field4:

DIASKINC

Cheshire Name:

( HFQ3327 )

HEST.DIASKINC

Item Text display:

Display "d." in front of LIST item text.

Item Text:

Calluses, infections, or other skin changes affecting the feet?

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP15 - DIAEYPRB ( HFQ3330 )

English text: YES
No

HFP15 - DIAEYPRB ( HFQ3330 )

English text: NO
Attribute

Route

Don't know

HFP15 - DIAEYPRB ( HFQ3330 )

Refusal

HFP15 - DIAEYPRB ( HFQ3330 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:17 PM Thursday, March 28, 2013

Page 414 of 789

HFP15

HFP15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAEYPRB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1860

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] have any problems with (your/his/her) eyes as a
result of (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:18 PM Thursday, March 28, 2013

Page 415 of 789

HFP15

Field1:

DIAEYPRB

Cheshire Name:

( HFQ3330 )

HEST.DIAEYPRB

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
HFP16A1 - DIAKDPEV ( HFQ3345 )

English text: YES
No

HFP16A1 - DIAKDPEV ( HFQ3345 )

English text: NO
Attribute

Route

Don't know

HFP16A1 - DIAKDPEV ( HFQ3345 )

Refusal

HFP16A1 - DIAKDPEV ( HFQ3345 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:19 PM Thursday, March 28, 2013

Page 416 of 789

HFP16A1

HFP16A1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAKDPEV

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

1872

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

[Have you/Has (SP)] ever had any problems with (your/his/her)

kidneys as a result of (your/his/her) diabetes?
[EXPLAIN IF NECESSARY: This is tested by looking for protein in
the urine.]

Int. Instr II:

INPUT FIELDS / ROUTING

4:19:20 PM Thursday, March 28, 2013

Page 417 of 789

HFP16A1

Field1:

DIAKDPEV

Cheshire Name:

( HFQ3345 )

HEST.DIAKDPEV

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP16 - DIAKDPRB ( HFQ3358 )

English text: YES
No

HFP17 - DIAMNGE ( HFQ3364 )

English text: NO
Attribute

Route

Don't know

HFP17 - DIAMNGE ( HFQ3364 )

Refusal

HFP17 - DIAMNGE ( HFQ3364 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:21 PM Thursday, March 28, 2013

Page 418 of 789

HFP16

HFP16

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAKDPRB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1876

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] currently have any problems with (your/his/her)
kidneys as a result of (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:22 PM Thursday, March 28, 2013

Page 419 of 789

HFP16

Field1:

DIAKDPRB

Cheshire Name:

( HFQ3358 )

HEST.DIAKDPRB

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
HFP16A - DIAKIDNY ( HFQ3361 )

English text: YES
No

HFP17 - DIAMNGE ( HFQ3364 )

English text: NO
Attribute

Route

Don't know

HFP17 - DIAMNGE ( HFQ3364 )

Refusal

HFP17 - DIAMNGE ( HFQ3364 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:23 PM Thursday, March 28, 2013

Page 420 of 789

HFP16A

HFP16A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAKIDNY

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

1879

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] ever been told by a doctor that (you have/she
has/he has) chronic kidney disease?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:23 PM Thursday, March 28, 2013

Page 421 of 789

HFP16A

Field1:

DIAKIDNY

Cheshire Name:

( HFQ3361 )

HEST.DIAKIDNY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP17 - DIAMNGE ( HFQ3364 )

English text: YES
No

HFP17 - DIAMNGE ( HFQ3364 )

English text: NO
Attribute

Route

Don't know

HFP17 - DIAMNGE ( HFQ3364 )

Refusal

HFP17 - DIAMNGE ( HFQ3364 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:25 PM Thursday, March 28, 2013

Page 422 of 789

HFP17

HFP17

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAMNGE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1882

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] ever participated in a diabetes selfmanagement course or class, or received special training on how
(you/he/she) can manage (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:25 PM Thursday, March 28, 2013

Page 423 of 789

HFP17

Field1:

DIAMNGE

Cheshire Name:

( HFQ3364 )

HEST.DIAMNGE

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP18 - DIATRAIN ( HFQ3367 )

English text: YES
No

BOX HFP7 - (HFQ3370 )

English text: NO
Attribute

Route

Don't know

BOX HFP7 - (HFQ3370 )

Refusal

BOX HFP7 - (HFQ3370 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:26 PM Thursday, March 28, 2013

Page 424 of 789

HFP18

HFP18

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIATRAIN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1885

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

When was the most recent time that [you/(SP)] participated in a
diabetes self-management course or class or received special
training on how (you/he/she) can manage (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:27 PM Thursday, March 28, 2013

Page 425 of 789

HFP18

Field1:

DIATRAIN

( HFQ3367 )

HEST.DIATRAIN

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYearAgoDKRF
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP7 - (HFQ3370 )

2

English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
BOX HFP7 - (HFQ3370 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
BOX HFP7 - (HFQ3370 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
BOX HFP7 - (HFQ3370 )

BOX HFP7 - (HFQ3370 )

English text: 5 OR MORE YEARS AGO
Attribute

Route

Don't know

BOX HFP7 - (HFQ3370 )

Refusal

BOX HFP7 - (HFQ3370 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:19:29 PM Thursday, March 28, 2013

Page 426 of 789

HFP18
DESIGN NOTES

4:19:29 PM Thursday, March 28, 2013

Page 427 of 789

BOX HFP7

BOX HFP7

Page Order # :

1886

BOX INSTRUCTIONS
( HFQ3370 )

IF THE SP IS THE RESPONDENT, GO TO HFP19 - DIAKNOW ( HFQ3373 ).
ELSE GO TO BOX HFR1 - (HFQ3397 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:19:29 PM Thursday, March 28, 2013

Page 428 of 789

HFP19

HFP19

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIAKNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1888

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF3

Question Text:

How much do you think you know about managing your diabetes?
Do you know . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:30 PM Thursday, March 28, 2013

Page 429 of 789

HFP19

Field1:

DIAKNOW

Cheshire Name:

( HFQ3373 )

HEST.DIAKNOW

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDiaknow
1
No
No

Number Label
1 EverythingNeedToKnow

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP20 - DIASUPPS ( HFQ3376 )

2

English text: just about everything you need to know,
MostNeedToKnow
HFP20 - DIASUPPS ( HFQ3376 )

3

English text: most of what you need to know,
SomeNeedToKnow

HFP20 - DIASUPPS ( HFQ3376 )

4

English text: some of what you need to know,
AlittleNeedToKnow

HFP20 - DIASUPPS ( HFQ3376 )

5

English text: a little of what you need to know, or
NoneNeedToKnow
HFP20 - DIASUPPS ( HFQ3376 )
English text: almost none of what you need to know about managing your diabetes?

Attribute

Route

Don't know

HFP20 - DIASUPPS ( HFQ3376 )

Refusal

HFP20 - DIASUPPS ( HFQ3376 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:19:31 PM Thursday, March 28, 2013

Page 430 of 789

HFP19
DESIGN NOTES

4:19:31 PM Thursday, March 28, 2013

Page 431 of 789

HFP20

HFP20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIASUPPS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1890

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Before today, did you know that Medicare now helps pay the cost of
diabetic testing supplies and self-management education for people
with diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:32 PM Thursday, March 28, 2013

Page 432 of 789

HFP20

Field1:

DIASUPPS

Cheshire Name:

( HFQ3376 )

HEST.DIASUPPS

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFR1 - (HFQ3397 )

English text: YES
No

BOX HFR1 - (HFQ3397 )

English text: NO
Attribute

Route

Don't know

BOX HFR1 - (HFQ3397 )

Refusal

BOX HFR1 - (HFQ3397 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:33 PM Thursday, March 28, 2013

Page 433 of 789

HFP21

HFP21

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAEVERT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1895

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

HFJ41A - OCBETES = 2/No, display first sentence.
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[I have recorded that [you have/(SP) has] never been told by a

doctor that (you have/she has/he has) diabetes.]
[Have you/Has (SP)] ever had a blood test to see if (you have/she
has/he has) diabetes?

Int. Instr II:

INPUT FIELDS / ROUTING

4:19:34 PM Thursday, March 28, 2013

Page 434 of 789

HFP21

Field1:

DIAEVERT

Cheshire Name:
Item Text display:

( HFQ3379 )

HEST.DIAEVERT

Do not display response option 3/SPHasDiabetes.

Item Text:

Label:

Label Position:

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

Enumerated

TDiaEvert

1
No
No

Number Label
1 Yes

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFP22 - DIARECNT ( HFQ3382 )

2

English text: YES
No

3

English text: NO
SPHasDiabetes

BOX HFP8 - (HFQ3385 )

DO NOT DISPLAY.

DATA EDITING ONLY.

Attribute

Route

Don't know

BOX HFP8 - (HFQ3385 )

Refusal

BOX HFP8 - (HFQ3385 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:35 PM Thursday, March 28, 2013

Page 435 of 789

HFP22

HFP22

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIARECNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1900

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

When was the most recent time [you were/(SP) was] tested for
diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:36 PM Thursday, March 28, 2013

Page 436 of 789

HFP22

Field1:

DIARECNT

( HFQ3382 )

HEST.DIARECNT

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYearAgoDKRF
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP24 - DIARISK ( HFQ3391 )

2

English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
HFP24 - DIARISK ( HFQ3391 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
HFP24 - DIARISK ( HFQ3391 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFP24 - DIARISK ( HFQ3391 )

HFP24 - DIARISK ( HFQ3391 )

English text: 5 OR MORE YEARS AGO
Attribute

Route

Don't know

HFP24 - DIARISK ( HFQ3391 )

Refusal

HFP24 - DIARISK ( HFQ3391 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:19:37 PM Thursday, March 28, 2013

Page 437 of 789

HFP22
DESIGN NOTES

4:19:37 PM Thursday, March 28, 2013

Page 438 of 789

BOX HFP8

BOX HFP8

Page Order # :

1905

BOX INSTRUCTIONS
( HFQ3385 )

IF THE SP IS THE RESPONDENT, GO TO HFP23 - DIAAWARE ( HFQ3388
).
ELSE GO TO HFP24 - DIARISK ( HFQ3391 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:19:37 PM Thursday, March 28, 2013

Page 439 of 789

HFP23

HFP23

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAAWARE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1910

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Before today, were you aware that there is a blood test to determine
if a person has diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:38 PM Thursday, March 28, 2013

Page 440 of 789

HFP23

Field1:

DIAAWARE

Cheshire Name:

( HFQ3388 )

HEST.DIAAWARE

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP24 - DIARISK ( HFQ3391 )

English text: YES
No

HFP24 - DIARISK ( HFQ3391 )

English text: NO
Attribute

Route

Don't know

HFP24 - DIARISK ( HFQ3391 )

Refusal

HFP24 - DIARISK ( HFQ3391 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:39 PM Thursday, March 28, 2013

Page 441 of 789

HFP24

HFP24

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIARISK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1915

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Has a doctor or other health professional ever told [you/(SP)] that
(you are/he is/she is) at high risk for diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:40 PM Thursday, March 28, 2013

Page 442 of 789

HFP24

Field1:

DIARISK

Cheshire Name:

( HFQ3391 )

HEST.DIARISK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP25 - DIASIGNS ( HFQ3394 )

English text: YES
No

HFP25 - DIASIGNS ( HFQ3394 )

English text: NO
Attribute

Route

Don't know

HFP25 - DIASIGNS ( HFQ3394 )

Refusal

HFP25 - DIASIGNS ( HFQ3394 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:41 PM Thursday, March 28, 2013

Page 443 of 789

HFP25

HFP25

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIASIGNS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1920

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

In the past year, [have you/has (SP)] received any information about
the signs, symptoms, or risk factors for diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:42 PM Thursday, March 28, 2013

Page 444 of 789

HFP25

Field1:

DIASIGNS

Cheshire Name:

( HFQ3394 )

HEST.DIASIGNS

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFR1 - (HFQ3397 )

English text: YES
No

BOX HFR1 - (HFQ3397 )

English text: NO
Attribute

Route

Don't know

BOX HFR1 - (HFQ3397 )

Refusal

BOX HFR1 - (HFQ3397 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:43 PM Thursday, March 28, 2013

Page 445 of 789

BOX HFR1

BOX HFR1

Page Order # :

1922

BOX INSTRUCTIONS
( HFQ3397 )

IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS
UNKNOWN) AND (SP HAS NOT REPORTED HAVING COLON, RECTAL OR
BOWEL CANCER IN THE CURRENT ROUND OR IN A PREVIOUS ROUND),
GO TO HFR1 - COLHEAR ( HFQ3400 ).
ELSE GO TO BOX HFS0 - (HFQ3447 ).

ASSIGNMENTS

TECHNICAL NOTES
447

SPEverHrdColonCUnkn

SP has ever heard about colorectal or colon cancer is
unknown = There is no HEST wshere HEST.HESTRND
< current round and HEST.COLHEAR ^= EMPTY.

448

SPNotRepColonCCurPr
ev

SP has not reported having colon, rectal, or bowel cancer
in the current round or in a previous round = There is no
HEST where HEST.HESTRND <= current round and
HEST.OCCCODE includes 2/Colon.

DESIGN NOTES

4:19:43 PM Thursday, March 28, 2013

Page 446 of 789

HFR1

HFR1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLHEAR

Enable Functions:

HELP
COMMENTS
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Yes
Yes
No

Roster Functions:

Add Item
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No
No
No
No

Grid Functions:

Add Line
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No
No

1924

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now I'd like to talk about a different illness, colorectal or colon
cancer, a disease of the lower intestines.
Before today, had you ever heard of colorectal or colon cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:43 PM Thursday, March 28, 2013

Page 447 of 789

HFR1

Field1:

COLHEAR

Cheshire Name:

( HFQ3400 )

HEST.COLHEAR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR3 - COLHTEST ( HFQ3410 )

English text: YES
No

HFR3 - COLHTEST ( HFQ3410 )

English text: NO
Attribute

Route

Don't know

HFR3 - COLHTEST ( HFQ3410 )

Refusal

HFR3 - COLHTEST ( HFQ3410 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:44 PM Thursday, March 28, 2013

Page 448 of 789

HFR3

HFR3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLHTEST

Enable Functions:

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Yes
Yes
No

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Add Item
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No
No
No
No

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No
No

1926

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

The fecal occult blood test is a simple test for early signs of colon
cancer. It detects invisible traces of blood found in the stool. The
doctor or other health professional can give the patient a kit to collect
stool samples at the patient’s home. The test is then sent to a
laboratory for the results to be determined.
Has a doctor or other health professional ever given [you/(SP)] a
home testing kit to test for blood in the stool?

Int. Instr II:

4:19:45 PM Thursday, March 28, 2013

Page 449 of 789

HFR3
INPUT FIELDS / ROUTING
COLHTEST

Field1:
Cheshire Name:

( HFQ3410 )

HEST.COLHTEST

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR5 - COLCARD ( HFQ3420 )

English text: YES
No

HFR4 - COLHKIT ( HFQ3415 )

English text: NO
Attribute
Don't know

Route
HFR4 - COLHKIT ( HFQ3415 )

Refusal

HFR4 - COLHKIT ( HFQ3415 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:46 PM Thursday, March 28, 2013

Page 450 of 789

HFR4

HFR4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLHKIT

Enable Functions:

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Yes
Yes
No

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Add Item
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No
No
No
No

Grid Functions:

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No
No

1928

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Have you ever heard of this home testing kit?

Int. Instr II:

INPUT FIELDS / ROUTING

4:19:47 PM Thursday, March 28, 2013

Page 451 of 789

HFR4

Field1:

COLHKIT

Cheshire Name:

( HFQ3415 )

HEST.COLHKIT

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
HFR4A - COLFDOC ( HFQ3417 )

English text: YES
No

HFR4A - COLFDOC ( HFQ3417 )

English text: NO
Attribute

Route

Don't know

HFR4A - COLFDOC ( HFQ3417 )

Refusal

HFR4A - COLFDOC ( HFQ3417 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:48 PM Thursday, March 28, 2013

Page 452 of 789

HFR4A

HFR4A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLFDOC

Enable Functions:

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COMMENTS
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No
Yes
No

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Add Item
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No
No
No
No

Grid Functions:

Add Line
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No
No

1929

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Has a doctor or other health professional ever performed a fecal
occult blood test to test for blood in the stool while [you/(SP)] were at
the doctor’s office?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:49 PM Thursday, March 28, 2013

Page 453 of 789

HFR4A

Field1:

COLFDOC

Cheshire Name:

( HFQ3417 )

HEST.COLFDOC

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR7 - COLRECNT ( HFQ3423 )

English text: YES
No

HFR8 - COLSCOPY ( HFQ3427 )

English text: NO
Attribute

Route

Don't know

HFR8 - COLSCOPY ( HFQ3427 )

Refusal

HFR8 - COLSCOPY ( HFQ3427 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:50 PM Thursday, March 28, 2013

Page 454 of 789

HFR5

HFR5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLCARD

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
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No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1930

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Did [you/(SP)] complete the samples and return them for
(your/his/her) most recent test?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:51 PM Thursday, March 28, 2013

Page 455 of 789

HFR5

Field1:

COLCARD

Cheshire Name:

( HFQ3420 )

HEST.COLCARD

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR7 - COLRECNT ( HFQ3423 )

English text: YES
No

HFR7 - COLRECNT ( HFQ3423 )

English text: NO
Attribute

Route

Don't know

HFR7 - COLRECNT ( HFQ3423 )

Refusal

HFR7 - COLRECNT ( HFQ3423 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:52 PM Thursday, March 28, 2013

Page 456 of 789

HFR7

HFR7

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

COLRECNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1932

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFR3-COLHTEST = 1/Yes, display " using a home testing kit".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

When did [you/(SP)] have (your/his/her) most recent blood stool test(

using a home testing kit)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:53 PM Thursday, March 28, 2013

Page 457 of 789

HFR7

Field1:

COLRECNT

Cheshire Name:

( HFQ3423 )

HEST.COLRECNT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYearago
1
No
No

Number Label
1 LessThan1YearAgo

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR8 - COLSCOPY ( HFQ3427 )

2

English text: LESS THAN 1 YEAR AGO
1YearToLessThan2YearsAgo

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
2YearsToLessThan3YearsAgo
HFR8 - COLSCOPY ( HFQ3427 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
3YearsToLessThan5YearsAgo
HFR8 - COLSCOPY ( HFQ3427 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
5OrMoreYearsAgo
HFR8 - COLSCOPY ( HFQ3427 )

HFR8 - COLSCOPY ( HFQ3427 )

English text: 5 OR MORE YEARS AGO
Attribute

Route

Don't know

HFR8 - COLSCOPY ( HFQ3427 )

Refusal

HFR8 - COLSCOPY ( HFQ3427 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:19:54 PM Thursday, March 28, 2013

Page 458 of 789

HFR7
DESIGN NOTES

4:19:54 PM Thursday, March 28, 2013

Page 459 of 789

HFR8

HFR8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLSCOPY

Enable Functions:

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Yes
Yes
No

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No
No
No
No

Grid Functions:

Add Line
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No
No

1934

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Another test for early signs of colon cancer is performed in the
doctor's office. The doctor uses a flexible lighted tube to examine the
colon and rectum directly. This is called a sigmoidoscopy or
colonoscopy.
[Have you/Has (SP)] ever had this exam?

Int. Instr II:

INPUT FIELDS / ROUTING

4:19:55 PM Thursday, March 28, 2013

Page 460 of 789

HFR8

Field1:

COLSCOPY

Cheshire Name:

( HFQ3427 )

HEST.COLSCOPY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR9 - WHENSCOP ( HFQ3430 )

English text: YES
No

HFR10 - HEARSCOP ( HFQ3435 )

English text: NO
Attribute

Route

Don't know

HFR10 - HEARSCOP ( HFQ3435 )

Refusal

HFR10 - HEARSCOP ( HFQ3435 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:19:56 PM Thursday, March 28, 2013

Page 461 of 789

HFR9

HFR9

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

WHENSCOP

Enable Functions:

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Yes
Yes
No

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Add Item
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No
No
No
No

Grid Functions:

Add Line
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No
No

1936

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

When did [you/(SP)] have (your/his/her) most recent sigmoidoscopy
or colonoscopy?

Int. Instr II:
INPUT FIELDS / ROUTING

4:19:57 PM Thursday, March 28, 2013

Page 462 of 789

HFR9

Field1:

WHENSCOP

Cheshire Name:

( HFQ3430 )

HEST.WHENSCOP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYearago
1
No
No

Number Label
1 LessThan1YearAgo

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR13 - COLSCRNS ( HFQ3444 )

2

English text: LESS THAN 1 YEAR AGO
1YearToLessThan2YearsAgo

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
2YearsToLessThan3YearsAgo
HFR13 - COLSCRNS ( HFQ3444 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
3YearsToLessThan5YearsAgo
HFR13 - COLSCRNS ( HFQ3444 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
5OrMoreYearsAgo
HFR13 - COLSCRNS ( HFQ3444 )

HFR13 - COLSCRNS ( HFQ3444 )

English text: 5 OR MORE YEARS AGO
Attribute

Route

Don't know

HFR13 - COLSCRNS ( HFQ3444 )

Refusal

HFR13 - COLSCRNS ( HFQ3444 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:19:59 PM Thursday, March 28, 2013

Page 463 of 789

HFR9
DESIGN NOTES

4:19:59 PM Thursday, March 28, 2013

Page 464 of 789

HFR10

HFR10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HEARSCOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1938

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Before today, had you ever heard of a sigmoidoscopy or
colonoscopy?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:00 PM Thursday, March 28, 2013

Page 465 of 789

HFR10

Field1:

HEARSCOP

Cheshire Name:

( HFQ3435 )

HEST.HEARSCOP

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR11 - COLDRREC ( HFQ3441 )

English text: YES
No

BOX HFR2 - (HFQ3438 )

English text: NO
Attribute

Route

Don't know

BOX HFR2 - (HFQ3438 )

Refusal

BOX HFR2 - (HFQ3438 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:01 PM Thursday, March 28, 2013

Page 466 of 789

BOX HFR2

BOX HFR2

Page Order # :

1940

BOX INSTRUCTIONS
( HFQ3438 )

IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 ­
COLSCRNS ( HFQ3444 ).
ELSE GO TO BOX HFS0 - (HFQ3447 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:20:01 PM Thursday, March 28, 2013

Page 467 of 789

HFR11

HFR11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLDRREC

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1942

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Has a doctor ever recommended that [you/(SP)] have this test?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:01 PM Thursday, March 28, 2013

Page 468 of 789

HFR11

Field1:

COLDRREC

Cheshire Name:

( HFQ3441 )

HEST.COLDRREC

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR13 - COLSCRNS ( HFQ3444 )

English text: YES
No

HFR13 - COLSCRNS ( HFQ3444 )

English text: NO
Attribute

Route

Don't know

HFR13 - COLSCRNS ( HFQ3444 )

Refusal

HFR13 - COLSCRNS ( HFQ3444 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:03 PM Thursday, March 28, 2013

Page 469 of 789

HFR13

HFR13

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLSCRNS

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1944

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Before today, did you know that Medicare now pays the cost of
screening tests for colorectal cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:03 PM Thursday, March 28, 2013

Page 470 of 789

HFR13

Field1:

COLSCRNS

Cheshire Name:

( HFQ3444 )

HEST.COLSCRNS

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFS0 - (HFQ3447 )

English text: YES
No

BOX HFS0 - (HFQ3447 )

English text: NO
Attribute

Route

Don't know

BOX HFS0 - (HFQ3447 )

Refusal

BOX HFS0 - (HFQ3447 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:04 PM Thursday, March 28, 2013

Page 471 of 789

BOX HFS0

BOX HFS0

Page Order # :

1946

BOX INSTRUCTIONS
( HFQ3447 )

IF THIS IS ROUND 67, GO TO HFAC29 - HCTROUBL ( HFQ3490 ).
ELSE GO TO BOX HFS1 - (HFQ3450 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:20:04 PM Thursday, March 28, 2013

Page 472 of 789

BOX HFS1

BOX HFS1

Page Order # :

1960

BOX INSTRUCTIONS
( HFQ3450 )

IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT
ROUND OR IN A PREVIOUS ROUND, GO TO HFS3 - OSTTEST ( HFQ3470
).
ELSE GO TO HFSINTRO - OSTINTRO ( HFQ3455 ).

ASSIGNMENTS

TECHNICAL NOTES
407

HFOsteoporosisCurrOr
Prev

SP has ever reported having osteoporosis in the current
round or in a previous round =
There is a HEST where HEST.HESTRND <= current
round and HEST.OCOSTEOP = 1/Yes.

DESIGN NOTES

4:20:04 PM Thursday, March 28, 2013

Page 473 of 789

HFSINTRO

HFSINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

OSTINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1965

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now I'd like to talk about a disease called osteoporosis, which can
be treated if found early. In osteoporosis, the bones lose their
calcium and become fragile and more easily broken.

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:05 PM Thursday, March 28, 2013

Page 474 of 789

HFSINTRO

Field1:

OSTINTRO

Cheshire Name:

( HFQ3455 )

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
HFS1 - OSTEVERT ( HFQ3460 )

English text: CONTINUE
Attribute

Route

Empty

HFS1 - OSTEVERT ( HFQ3460 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:06 PM Thursday, March 28, 2013

Page 475 of 789

HFS1

HFS1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTEVERT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1970

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] ever talked with (your/his/her) doctor or other
health professional about osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:07 PM Thursday, March 28, 2013

Page 476 of 789

HFS1

Field1:

OSTEVERT

Cheshire Name:

( HFQ3460 )

HEST.OSTEVERT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS2 - OSTHRISK ( HFQ3465 )

English text: YES
No

HFS3 - OSTTEST ( HFQ3470 )

English text: NO
Attribute

Route

Don't know

HFS3 - OSTTEST ( HFQ3470 )

Refusal

HFS3 - OSTTEST ( HFQ3470 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:08 PM Thursday, March 28, 2013

Page 477 of 789

HFS2

HFS2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTHRISK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1980

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Has a doctor or other health professional ever told [you/(SP)] that
(you are/he is/she is) at high risk for osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:08 PM Thursday, March 28, 2013

Page 478 of 789

HFS2

Field1:

OSTHRISK

Cheshire Name:

( HFQ3465 )

HEST.OSTHRISK

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
HFS2A - OSTFRACT ( HFQ3467 )

English text: YES
No

HFS2A - OSTFRACT ( HFQ3467 )

English text: NO
Attribute

Route

Don't know

HFS2A - OSTFRACT ( HFQ3467 )

Refusal

HFS2A - OSTFRACT ( HFQ3467 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:10 PM Thursday, March 28, 2013

Page 479 of 789

HFS2A

HFS2A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTFRACT

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

1985

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Have [you/(SP)] ever experienced a fracture that (your/his/her)
doctor told (you/him/her) was related to osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:10 PM Thursday, March 28, 2013

Page 480 of 789

HFS2A

Field1:

OSTFRACT

Cheshire Name:

( HFQ3467 )

HEST.OSTFRACT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS3 - OSTTEST ( HFQ3470 )

English text: YES
No

HFS3 - OSTTEST ( HFQ3470 )

English text: NO
Attribute

Route

Don't know

HFS3 - OSTTEST ( HFQ3470 )

Refusal

HFS3 - OSTTEST ( HFQ3470 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:11 PM Thursday, March 28, 2013

Page 481 of 789

HFS3

HFS3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTTEST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1990

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "Mass" and "Density" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

There is a test to detect osteoporosis at an early stage, called Bone

Mass Measurement or Bone Density Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density
Measurement test?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:12 PM Thursday, March 28, 2013

Page 482 of 789

HFS3

Field1:

OSTTEST

Cheshire Name:

( HFQ3470 )

HEST.OSTTEST

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS5 - OSTRECNT ( HFQ3482 )

English text: YES
No

HFS4 - OSTHEAR ( HFQ3475 )

English text: NO
Attribute

Route

Don't know

HFS4 - OSTHEAR ( HFQ3475 )

Refusal

HFS4 - OSTHEAR ( HFQ3475 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:13 PM Thursday, March 28, 2013

Page 483 of 789

HFS4

HFS4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTHEAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2000

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Before today, had you ever heard of this test?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:14 PM Thursday, March 28, 2013

Page 484 of 789

HFS4

Field1:

OSTHEAR

Cheshire Name:

( HFQ3475 )

HEST.OSTHEAR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS6 - OSTMASS ( HFQ3485 )

English text: YES
No

HFAC29 - HCTROUBL ( HFQ3490 )

English text: NO
Attribute

Route

Don't know

HFAC29 - HCTROUBL ( HFQ3490 )

Refusal

HFAC29 - HCTROUBL ( HFQ3490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:15 PM Thursday, March 28, 2013

Page 485 of 789

HFS5

HFS5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

OSTRECNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2010

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

When was the most recent time that [you/(SP)] had a Bone Mass or
Bone Density Measurement test?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:16 PM Thursday, March 28, 2013

Page 486 of 789

HFS5

Field1:

OSTRECNT

( HFQ3482 )

HEST.OSTRECNT

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYearAgoDKRF
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS6 - OSTMASS ( HFQ3485 )

2

English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
HFS6 - OSTMASS ( HFQ3485 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
HFS6 - OSTMASS ( HFQ3485 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFS6 - OSTMASS ( HFQ3485 )

HFS6 - OSTMASS ( HFQ3485 )

English text: 5 OR MORE YEARS AGO
Attribute

Route

Don't know

HFS6 - OSTMASS ( HFQ3485 )

Refusal

HFS6 - OSTMASS ( HFQ3485 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:20:17 PM Thursday, March 28, 2013

Page 487 of 789

HFS5
DESIGN NOTES

4:20:17 PM Thursday, March 28, 2013

Page 488 of 789

HFS6

HFS6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTMASS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2020

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Before today, did you know that Medicare would pay for Bone Mass
or Bone Density Measurement tests for Medicare beneficiaries who
are at risk for osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:18 PM Thursday, March 28, 2013

Page 489 of 789

HFS6

Field1:

OSTMASS

Cheshire Name:

( HFQ3485 )

HEST.OSTMASS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC29 - HCTROUBL ( HFQ3490 )

English text: YES
No

HFAC29 - HCTROUBL ( HFQ3490 )

English text: NO
Attribute

Route

Don't know

HFAC29 - HCTROUBL ( HFQ3490 )

Refusal

HFAC29 - HCTROUBL ( HFQ3490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:19 PM Thursday, March 28, 2013

Page 490 of 789

HFAC29

HFAC29

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HCTROUBL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2050

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "past year" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Next, we are going to ask some questions about [your/(SP's)] health

care needs during the past year.
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any
trouble getting health care that (you/he/she) wanted or needed?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:20 PM Thursday, March 28, 2013

Page 491 of 789

HFAC29

Field1:

HCTROUBL

Cheshire Name:

( HFQ3490 )

ACCS.HCTROUBL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30A - HCTCODE ( HFQ3510 )

English text: YES
No

HFAC31 - HCDELAY ( HFQ3660 )

English text: NO
Attribute

Route

Don't know

HFAC31 - HCDELAY ( HFQ3660 )

Refusal

HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:21 PM Thursday, March 28, 2013

Page 492 of 789

HFAC30A

HFAC30A

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

HCTCODE

Field 2:

HCTOTHOS

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

2060

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Why was that?

[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:20:22 PM Thursday, March 28, 2013

Page 493 of 789

HFAC30A

4:20:24 PM Thursday, March 28, 2013

Page 494 of 789

HFAC30A

Field1:

HCTCODE

Cheshire Name:

( HFQ3510 )

NONE
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.HCTMONEY
2=ACCS.HCTHIGH
3=ACCS.HCTNOCOV
4=ACCS.HCTTRANS
5=ACCS.HCTHOMEH
6=ACCS.HCTNTREA
7=ACCS.HCTWAIT
8=ACCS.HCTACPMC
9=ACCS.HCTELIG
10=ACCS.HCTDELAY
11=ACCS.HCTSPECL
12=ACCS.HCTHMORF
13=ACCS.HCTHMOMD
14=ACCS.HCTHMOCV
91=ACCS.HCTOTHER

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
THCTCode
15
No
No

Number Label
1 NoMoney

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF6 - (HFQ3537 )

2

English text: SP DOES NOT HAVE MONEY
CostTooHigh

BOX HFF6 - (HFQ3537 )

3

English text: COST IS TOO HIGH
ServiceNotCovered

BOX HFF6 - (HFQ3537 )

4

English text: SERVICES/SUPPLIES NOT COVERED
NeededTransportation
BOX HFF6 - (HFQ3537 )

5

English text: NEEDED TRANSPORTATION TO DOCTOR/HOSPITAL
DifficultyGettingHHCare
BOX HFF6 - (HFQ3537 )

6

English text: DIFFICULTY GETTING HOME HEALTH CARE
NoTreatmentAvailable
BOX HFF6 - (HFQ3537 )

7

English text: NO TREATMENT AVAILABLE/DOCTOR WON’T TREAT
WaitTooLong
BOX HFF6 - (HFQ3537 )
English text: WAIT TOO LONG/DOCTOR TOO BUSY

4:20:27 PM Thursday, March 28, 2013

Page 495 of 789

HFAC30A

8

DrDoesNotAcceptMedicare

BOX HFF6 - (HFQ3537 )

9

English text: OWN DOCTOR DOESN’T ACCEPT MEDICARE/COULDN’T FIND DOCTOR WHO
ACCEPTS MEDICARE
NotEligible
BOX HFF6 - (HFQ3537 )

10

English text: NOT ELIGIBLE FOR PUBLIC COVERAGE
DifficultyGettingAppt
BOX HFF6 - (HFQ3537 )

11

English text: DIFFICULTY GETTING APPOINTMENT/ DELAYS BECAUSE SP ON MEDICARE
ReferredToSpecialist
BOX HFF6 - (HFQ3537 )

12

English text: DOCTOR REFERRED SP TO SPECIALIST OR OTHER DOCTOR
HMOReferralProcess
BOX HFF6 - (HFQ3537 )

13

English text: HMO REFERRAL PROCESS (DIFFICULTY GETTING)
HMODrNotGood
BOX HFF6 - (HFQ3537 )

14

English text: PROBLEMS WITH HMO DOCTORS NOT GOOD OR AVAILABLE
HMONotCoverService
BOX HFF6 - (HFQ3537 )

91

English text: HMO WOULD NOT COVER OR PROVIDE SERVICE
Other
HFAC30A - HCTOTHOS ( HFQ3530 )
English text: OTHER

Attribute
Don't know

Route
BOX HFF6 - (HFQ3537 )

Refusal

BOX HFF6 - (HFQ3537 )

Field2:
Cheshire Name:

HCTOTHOS

( HFQ3530 )

ACCS.HCTOTHOS

Item Text display:

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

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String
TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

4:20:30 PM Thursday, March 28, 2013

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFF6 - (HFQ3537 )

Page 496 of 789

HFAC30A
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:30 PM Thursday, March 28, 2013

Page 497 of 789

BOX HFF6

BOX HFF6

Page Order # :

2070

BOX INSTRUCTIONS
( HFQ3537 )

IF RESPONSE TO HFAC30A - HCTCODE INCLUDES
8/DrDoesNotAcceptMedicare OR 10/DifficultyGettingAppt, GO TO HFAC30D ­
OFFEXPLN ( HFQ3565 ).
ELSE GO TO HFAC30B - CGETAPPT ( HFQ3544 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:20:30 PM Thursday, March 28, 2013

Page 498 of 789

HFAC30B

HFAC30B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

CGETAPPT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2080

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a
doctor’s office that they cannot schedule an appointment with
[you/(SP)]?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:30 PM Thursday, March 28, 2013

Page 499 of 789

HFAC30B

Field1:

CGETAPPT

Cheshire Name:

( HFQ3544 )

ACCS.CGETAPPT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30C - CGETCODE ( HFQ3551 )

English text: YES
No

HFAC31 - HCDELAY ( HFQ3660 )

English text: NO
Attribute

Route

Don't know

HFAC31 - HCDELAY ( HFQ3660 )

Refusal

HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:31 PM Thursday, March 28, 2013

Page 500 of 789

HFAC30C

HFAC30C

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

CGETCODE

Field 2:

CGETOTOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2090

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

What were the reasons the doctor’s office offered as an explanation

for not scheduling an appointment with [you/(SP)]?
[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY

INPUT FIELDS / ROUTING

4:20:32 PM Thursday, March 28, 2013

Page 501 of 789

HFAC30C

4:20:34 PM Thursday, March 28, 2013

Page 502 of 789

HFAC30C

Field1:

CGETCODE

Cheshire Name:

( HFQ3551 )

NONE
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.CGETINSR
2=ACCS.CGETFULL
3=ACCS.CGETNNEW
4=ACCS.CGETNNMP
5=ACCS.CGETHOUR
6=ACCS.CGETCAID
7=ACCS.CGETNAMC
8=ACCS.CGETNAMA
9=ACCS.CGETAPRV
91=ACCS.CGETOTHR

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TCgetCod
10
No
No

Number Label
1 DocNotAcceptPlan

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF7 - (HFQ3558 )

2

English text: DOCTOR DOES NOT ACCEPT INSURANCE PLAN
AllDocApptsFull
BOX HFF7 - (HFQ3558 )

3

English text: ALL OF DOCTORS APPOINTMENTS WERE FULL
DocNotAcceptNewPat
BOX HFF7 - (HFQ3558 )

4

English text: DOCTOR IS NOT ACCEPTING ANY NEW PATIENTS
DocNotAcceptNewMedicare
BOX HFF7 - (HFQ3558 )

5

English text: DOCTOR IS NOT ACCEPTING NEW MEDICARE PATIENTS
DocHoursConflicted
BOX HFF7 - (HFQ3558 )

6

English text: DOCTRS HOURS CONFLICTED WITH REQUIREMENTS OF SP
DocNotAcceptMCAD
BOX HFF7 - (HFQ3558 )

7

English text: DOCTOR DOES NOT ACCEPT MEDICAID
DocNotAcceptMCAR
BOX HFF7 - (HFQ3558 )

8

English text: DOCTOR DOES NOT ACCEPT MEDICARE AT ALL
DocNotAcceptAssign
BOX HFF7 - (HFQ3558 )

9

English text: DOCTOR DOES NOT ACCEPT MEDICARE ASSIGNMENT
DocAnotherProviderBetter
BOX HFF7 - (HFQ3558 )
English text: DOCTOR FELT ANOTHER PROVIDER WOULD BE BETTER FOR SP

4:20:37 PM Thursday, March 28, 2013

Page 503 of 789

HFAC30C

91

Other

HFAC30C - CGETOTOS ( HFQ3555 )

English text: OTHER
Attribute

Route

Don't know

BOX HFF7 - (HFQ3558 )

Refusal

BOX HFF7 - (HFQ3558 )

Field2:
Cheshire Name:

CGETOTOS

( HFQ3555 )

ACCS.CGETOTOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFF7 - (HFQ3558 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:38 PM Thursday, March 28, 2013

Page 504 of 789

BOX HFF7

BOX HFF7

Page Order # :

2100

BOX INSTRUCTIONS
( HFQ3558 )

IF RESPONSE TO HFAC30C - CGETCODE INCLUDES
4/DocNotAcceptNewMedicare OR 7/DocNotAcceptMCAR, GO TO HFAC30D ­
OFFEXPLN ( HFQ3565 ).
ELSE GO TO HFAC31 - HCDELAY ( HFQ3660 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:20:38 PM Thursday, March 28, 2013

Page 505 of 789

HFAC30D

HFAC30D

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OFFEXPLN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2110

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If response to HFAC30a includes 10/DifficultyGettingAppt, display
"it is difficult for Medicare patients to get an appointment".
Else display "Medicare is not accepted".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Did the doctor’s office explain why (it is difficult for Medicare patients

to get an appointment/Medicare is not accepted) at that practice?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:39 PM Thursday, March 28, 2013

Page 506 of 789

HFAC30D

Field1:

OFFEXPLN

( HFQ3565 )

Cheshire Name:

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30E - OFFEXVB ( HFQ3572 )

English text: YES
No

HFAC31 - HCDELAY ( HFQ3660 )

English text: NO
Attribute

Route

Don't know

HFAC31 - HCDELAY ( HFQ3660 )

Refusal

HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:40 PM Thursday, March 28, 2013

Page 507 of 789

HFAC30E

HFAC30E

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 1:

OFFEXVB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2120

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

What was that explanation?

Int. Instr II:

RECORD VERBATIM.

INPUT FIELDS / ROUTING

4:20:40 PM Thursday, March 28, 2013

Page 508 of 789

HFAC30E

Field1:
Cheshire Name:

OFFEXVB

( HFQ3572 )

NONE
REPLACES CHESHIRE VARIABLES:
ACCS.OFFEXVB1
ACCS.OFFEXVB2
DATA EDITING CODING VARIABLES:
ACCS.OFFEXVC1
ACCS.OFFEXVC2
ACCS.OFFEXVC3

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Open
TOpen90
1
No
No

Number Label
1

FieldSize:
Min Value:
Max Value:
Mask:

90

Route
HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:41 PM Thursday, March 28, 2013

Page 509 of 789

HFAC31

HFAC31

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HCDELAY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2148

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed
seeking medical care because (you were/he was/she was) worried
about the cost?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:41 PM Thursday, March 28, 2013

Page 510 of 789

HFAC31

Field1:

HCDELAY

Cheshire Name:

( HFQ3660 )

ACCS.HCDELAY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKINTRO - IADLINTRO ( HFQ3680 )

English text: YES
No

HFKINTRO - IADLINTRO ( HFQ3680 )

English text: NO
Attribute

Route

Don't know

HFKINTRO - IADLINTRO ( HFQ3680 )

Refusal

HFKINTRO - IADLINTRO ( HFQ3680 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:42 PM Thursday, March 28, 2013

Page 511 of 789

HFKINTRO

HFKINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

IADLINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2150

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "doing them by (yourself/himself/herself)" in BOLD.

Multi Field display:

Vertical Alignment

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

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

Now I'm going to ask about some everyday activities and whether
[you have/(SP) has] any difficulty doing them by
(yourself/himself/herself).

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:43 PM Thursday, March 28, 2013

Page 512 of 789

HFKINTRO

Field1:

IADLINTRO

Cheshire Name:

( HFQ3680 )

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
HFKA1 - PRBTELE ( HFQ3690 )

English text: CONTINUE
Attribute

Route

Empty

HFKA1 - PRBTELE ( HFQ3690 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:44 PM Thursday, March 28, 2013

Page 513 of 789

HFKA1

HFKA1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PRBTELE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2155

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
using the telephone?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:45 PM Thursday, March 28, 2013

Page 514 of 789

HFKA1

Field1:

PRBTELE

Cheshire Name:

( HFQ3690 )

IADL.PRBTELE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKB1 - PRBLHWK ( HFQ3700 )

2

English text: YES
No

HFKB1 - PRBLHWK ( HFQ3700 )

3

English text: NO
DoesntDo

HFKA2 - DONTTELE ( HFQ3692 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKB1 - PRBLHWK ( HFQ3700 )

Refusal

HFKB1 - PRBLHWK ( HFQ3700 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:46 PM Thursday, March 28, 2013

Page 515 of 789

HFKA2

HFKA2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTTELE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2160

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that using the telephone is something that [you don't/(SP)

doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:47 PM Thursday, March 28, 2013

Page 516 of 789

HFKA2

Field1:

DONTTELE

Cheshire Name:

( HFQ3692 )

IADL.DONTTELE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKB1 - PRBLHWK ( HFQ3700 )

English text: YES
No

HFKB1 - PRBLHWK ( HFQ3700 )

English text: NO
Attribute

Route

Don't know

HFKB1 - PRBLHWK ( HFQ3700 )

Refusal

HFKB1 - PRBLHWK ( HFQ3700 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:48 PM Thursday, March 28, 2013

Page 517 of 789

HFKB1

HFKB1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PRBLHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2165

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Always display "(like washing...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
doing light housework (like washing dishes, straightening up, or light
cleaning)?

Int. Instr II:

4:20:48 PM Thursday, March 28, 2013

Page 518 of 789

HFKB1
INPUT FIELDS / ROUTING
PRBLHWK

Field1:
Cheshire Name:

( HFQ3700 )

IADL.PRBLHWK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKC1 - PRBHHWK ( HFQ3710 )

2

English text: YES
No

HFKC1 - PRBHHWK ( HFQ3710 )

3

English text: NO
DoesntDo

HFKB2 - DONTLHWK ( HFQ3702 )

English text: DOESN'T DO
Attribute

Route

Don't know

HFKC1 - PRBHHWK ( HFQ3710 )

Refusal

HFKC1 - PRBHHWK ( HFQ3710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:50 PM Thursday, March 28, 2013

Page 519 of 789

HFKB2

HFKB2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTLHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2170

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "(like washing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[You said that doing light housework (like washing dishes,
straightening up, or light cleaning) is something that [you don't/(SP)
doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:
4:20:50 PM Thursday, March 28, 2013

Page 520 of 789

HFKB2
INPUT FIELDS / ROUTING
DONTLHWK

Field1:
Cheshire Name:

( HFQ3702 )

IADL.DONTLHWK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKC1 - PRBHHWK ( HFQ3710 )

English text: YES
No

HFKC1 - PRBHHWK ( HFQ3710 )

English text: NO
Attribute
Don't know

Route
HFKC1 - PRBHHWK ( HFQ3710 )

Refusal

HFKC1 - PRBHHWK ( HFQ3710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:51 PM Thursday, March 28, 2013

Page 521 of 789

HFKC1

HFKC1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PRBHHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2175

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Always display "(like scrubbing...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
doing heavy housework (like scrubbing floors or washing windows)?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:52 PM Thursday, March 28, 2013

Page 522 of 789

HFKC1

Field1:

PRBHHWK

Cheshire Name:

( HFQ3710 )

IADL.PRBHHWK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKD1 - PRBMEAL ( HFQ3720 )

2

English text: YES
No

HFKD1 - PRBMEAL ( HFQ3720 )

3

English text: NO
DoesntDo

HFKC2 - DONTHHWK ( HFQ3712 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKD1 - PRBMEAL ( HFQ3720 )

Refusal

HFKD1 - PRBMEAL ( HFQ3720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:53 PM Thursday, March 28, 2013

Page 523 of 789

HFKC2

HFKC2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTHHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2180

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "(like scrubbing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that doing heavy housework (like scrubbing floors or

washing windows) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

4:20:54 PM Thursday, March 28, 2013

Page 524 of 789

HFKC2
INPUT FIELDS / ROUTING
DONTHHWK

Field1:
Cheshire Name:

( HFQ3712 )

IADL.DONTHHWK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKD1 - PRBMEAL ( HFQ3720 )

English text: YES
No

HFKD1 - PRBMEAL ( HFQ3720 )

English text: NO
Attribute
Don't know

Route
HFKD1 - PRBMEAL ( HFQ3720 )

Refusal

HFKD1 - PRBMEAL ( HFQ3720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:55 PM Thursday, March 28, 2013

Page 525 of 789

HFKD1

HFKD1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PRBMEAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2185

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
preparing (your/his/her) own meals?

Int. Instr II:
INPUT FIELDS / ROUTING

4:20:56 PM Thursday, March 28, 2013

Page 526 of 789

HFKD1

Field1:

PRBMEAL

Cheshire Name:

( HFQ3720 )

IADL.PRBMEAL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKE1 - PRBSHOP ( HFQ3730 )

2

English text: YES
No

HFKE1 - PRBSHOP ( HFQ3730 )

3

English text: NO
DoesntDo

HFKD2 - DONTMEAL ( HFQ3722 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKE1 - PRBSHOP ( HFQ3730 )

Refusal

HFKE1 - PRBSHOP ( HFQ3730 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:57 PM Thursday, March 28, 2013

Page 527 of 789

HFKD2

HFKD2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTMEAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2190

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that preparing (your/his/her) own meals is something that

[you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:58 PM Thursday, March 28, 2013

Page 528 of 789

HFKD2

Field1:

DONTMEAL

Cheshire Name:

( HFQ3722 )

IADL.DONTMEAL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKE1 - PRBSHOP ( HFQ3730 )

English text: YES
No

HFKE1 - PRBSHOP ( HFQ3730 )

English text: NO
Attribute

Route

Don't know

HFKE1 - PRBSHOP ( HFQ3730 )

Refusal

HFKE1 - PRBSHOP ( HFQ3730 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:20:59 PM Thursday, March 28, 2013

Page 529 of 789

HFKE1

HFKE1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PRBSHOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2195

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Always display "(such as...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
shopping for personal items (such as toilet items or medicines)?

Int. Instr II:

INPUT FIELDS / ROUTING

4:20:59 PM Thursday, March 28, 2013

Page 530 of 789

HFKE1

Field1:

PRBSHOP

Cheshire Name:

( HFQ3730 )

IADL.PRBSHOP

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

Enumerated
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKF1 - PRBBILS ( HFQ3740 )

2

English text: YES
No

HFKF1 - PRBBILS ( HFQ3740 )

3

English text: NO
DoesntDo

HFKE2 - DONTSHOP ( HFQ3732 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKF1 - PRBBILS ( HFQ3740 )

Refusal

HFKF1 - PRBBILS ( HFQ3740 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:01 PM Thursday, March 28, 2013

Page 531 of 789

HFKE2

HFKE2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTSHOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2200

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "(such as...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that shopping for personal items (such as toilet items or

medicines) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

4:21:01 PM Thursday, March 28, 2013

Page 532 of 789

HFKE2
INPUT FIELDS / ROUTING
DONTSHOP

Field1:
Cheshire Name:

( HFQ3732 )

IADL.DONTSHOP

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKF1 - PRBBILS ( HFQ3740 )

English text: YES
No

HFKF1 - PRBBILS ( HFQ3740 )

English text: NO
Attribute
Don't know

Route
HFKF1 - PRBBILS ( HFQ3740 )

Refusal

HFKF1 - PRBBILS ( HFQ3740 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:03 PM Thursday, March 28, 2013

Page 533 of 789

HFKF1

HFKF1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PRBBILS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2205

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Always display "(like keeping track...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
managing money (like keeping track of expenses or paying bills)?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:03 PM Thursday, March 28, 2013

Page 534 of 789

HFKF1

Field1:

PRBBILS

Cheshire Name:

( HFQ3740 )

IADL.PRBBILS

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

Enumerated
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFKA1 - (HFQ3810 )

2

English text: YES
No

BOX HFKA1 - (HFQ3810 )

3

English text: NO
DoesntDo

HFKF2 - DONTBILS ( HFQ3742 )

English text: DOESN'T DO
Attribute
Don't know

Route
BOX HFKA1 - (HFQ3810 )

Refusal

BOX HFKA1 - (HFQ3810 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:04 PM Thursday, March 28, 2013

Page 535 of 789

HFKF2

HFKF2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTBILS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2210

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "(like keeping track...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that managing money (like keeping track of expenses or

paying bills) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

4:21:05 PM Thursday, March 28, 2013

Page 536 of 789

HFKF2
INPUT FIELDS / ROUTING
DONTBILS

Field1:
Cheshire Name:

( HFQ3742 )

IADL.DONTBILS

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFKA1 - (HFQ3810 )

English text: YES
No

BOX HFKA1 - (HFQ3810 )

English text: NO
Attribute
Don't know

Route
BOX HFKA1 - (HFQ3810 )

Refusal

BOX HFKA1 - (HFQ3810 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:06 PM Thursday, March 28, 2013

Page 537 of 789

BOX HFKA1

BOX HFKA1

Page Order # :

2215

BOX INSTRUCTIONS
( HFQ3810 )

IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO
HFKA3 - HELPTELE ( HFQ3820 ).
ELSE GO TO BOX HFKB1 - (HFQ3828 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:06 PM Thursday, March 28, 2013

Page 538 of 789

HFKA3

HFKA3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPTELE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2220

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFKA1 - PRBTELE = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[[You said that [your/(SP's)] health makes using the telephone
difficult./You said that using the telephone is something that [you
don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...

4:21:07 PM Thursday, March 28, 2013

Page 539 of 789

HFKA3
using the telephone?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

HELPTELE

Cheshire Name:

( HFQ3820 )

IADL.HELPTELE

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKA4 - PERSON_HLPRTELE ( HFQ3822 )

English text: YES
No

BOX HFKB1 - (HFQ3828 )

English text: NO
Attribute

Route

Don't know

BOX HFKB1 - (HFQ3828 )

Refusal

BOX HFKB1 - (HFQ3828 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:08 PM Thursday, March 28, 2013

Page 540 of 789

HFKA4

HFKA4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRTELE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2225

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:21:08 PM Thursday, March 28, 2013

Page 541 of 789

HFKA4
Question Text:

You mentioned that [you receive/(SP) receives] help with using the
telephone. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRTELE

( HFQ3822 )

HLPR.HLPRTELE

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFKB1 - (HFQ3828 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:21:09 PM Thursday, March 28, 2013

Page 542 of 789

HFKA4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

Set HLPR.HLPRTELE = 1/Indicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:21:09 PM Thursday, March 28, 2013

Page 543 of 789

HFKA4
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:09 PM Thursday, March 28, 2013

Page 544 of 789

BOX HFKB1

BOX HFKB1

Page Order # :

2230

BOX INSTRUCTIONS
( HFQ3828 )

IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO
HFKB3 - HELPLHW K ( HFQ3830 ).
ELSE GO TO BOX HFKC1 - (HFQ3838 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:09 PM Thursday, March 28, 2013

Page 545 of 789

HFKB3

HFKB3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPLHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2235

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFKB1 - PRBLHWK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like washing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

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

4:21:10 PM Thursday, March 28, 2013

[[You said that [your/(SP's)] health makes doing light housework (like
washing dishes, straightening up, or light cleaning) difficult./You said
that doing light housework (like washing dishes, straightening up, or
light cleaning) is something that [you don't do/(SP) doesn't do].]]
Page 546 of 789

HFKB3
[Do you/Does (SP)] receive help from another person with...
doing light housework (like washing dishes, straightening up, or light
cleaning)?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPLHWK

Field1:
Cheshire Name:

( HFQ3830 )

IADL.HELPLHWK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKB4 - PERSON_HLPRLHWK ( HFQ3832 )

English text: YES
No

BOX HFKC1 - (HFQ3838 )

English text: NO
Attribute
Don't know

Route
BOX HFKC1 - (HFQ3838 )

Refusal

BOX HFKC1 - (HFQ3838 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:21:11 PM Thursday, March 28, 2013

Page 547 of 789

HFKB3

DESIGN NOTES

4:21:11 PM Thursday, March 28, 2013

Page 548 of 789

HFKB4

HFKB4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRLHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2240

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(like washing...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:21:11 PM Thursday, March 28, 2013

Page 549 of 789

HFKB4
Question Text:

You mentioned that [you receive/(SP) receives] help with doing light
housework (like washing dishes, straightening up, or light cleaning).
Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRLHWK ( HFQ3832 )

HLPR.HLPRLHWK

Item Text display:

Item Text:

Label:

Label Position:

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

String

TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFKC1 - (HFQ3838 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

4:21:12 PM Thursday, March 28, 2013

Page 550 of 789

HFKB4
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

Set HLPR.HLPRLHWK = 1/Indicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

4:21:12 PM Thursday, March 28, 2013

Page 551 of 789

HFKB4
HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:12 PM Thursday, March 28, 2013

Page 552 of 789

BOX HFKC1

BOX HFKC1

Page Order # :

2245

BOX INSTRUCTIONS
( HFQ3838 )

IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO
HFKC3 - HELPHHWK ( HFQ3840 ).
ELSE GO TO BOX HFKD1 - (HFQ3848 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:12 PM Thursday, March 28, 2013

Page 553 of 789

HFKC3

HFKC3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPHHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2250

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFKC1 - PRBHHWK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like scrubbing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

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

4:21:13 PM Thursday, March 28, 2013

[[You said that [your/(SP's)] health makes doing heavy housework
(like scrubbing floors or washing windows) difficult./You said that
heavy housework (like scrubbing floors or washing windows) is
something that [you don't do/(SP) doesn't do].]]
Page 554 of 789

HFKC3
[Do you/Does (SP)] receive help from another person with...
doing heavy housework (like scrubbing floors or washing windows)?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

HELPHHWK

Cheshire Name:

( HFQ3840 )

IADL.HELPHHWK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKC4 - PERSON_HLPRHHWK ( HFQ3842 )

English text: YES
No

BOX HFKD1 - (HFQ3848 )

English text: NO
Attribute
Don't know

Route
BOX HFKD1 - (HFQ3848 )

Refusal

BOX HFKD1 - (HFQ3848 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:21:14 PM Thursday, March 28, 2013

Page 555 of 789

HFKC3
DESIGN NOTES

4:21:14 PM Thursday, March 28, 2013

Page 556 of 789

HFKC4

HFKC4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRHHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2255

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(like scrubbing...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:21:14 PM Thursday, March 28, 2013

Page 557 of 789

HFKC4
Question Text:

You mentioned that [you receive/(SP) receives] help with doing
heavy housework (like scrubbing floors or washing windows). Who
gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRHHWK ( HFQ3842 )

HLPR.HLPRHHWK

Item Text display:

Item Text:

Label:

Label Position:

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

String

TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFKD1 - (HFQ3848 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

4:21:15 PM Thursday, March 28, 2013

Page 558 of 789

HFKC4
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

Set HLPR.HLPRHHWK = 1/Indicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

4:21:15 PM Thursday, March 28, 2013

Page 559 of 789

HFKC4
HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:15 PM Thursday, March 28, 2013

Page 560 of 789

BOX HFKD1

BOX HFKD1

Page Order # :

2260

BOX INSTRUCTIONS
( HFQ3848 )

IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO
HFKD3 - HELPMEAL ( HFQ3850 ).
ELSE GO TO BOX HFKE1 - (HFQ3858 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:15 PM Thursday, March 28, 2013

Page 561 of 789

HFKD3

HFKD3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPMEAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2265

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFKD1 - PRBMEAL = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[[You said that [your/(SP's)] health makes preparing (your/his/her)
own meals difficult./You said that preparing (your/his/her) own meals
is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...

4:21:16 PM Thursday, March 28, 2013

Page 562 of 789

HFKD3
preparing (your/his/her) own meals?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

HELPMEAL

Cheshire Name:

( HFQ3850 )

IADL.HELPMEAL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKD4 - PERSON_HLPRMEAL ( HFQ3852 )

English text: YES
No

BOX HFKE1 - (HFQ3858 )

English text: NO
Attribute

Route

Don't know

BOX HFKE1 - (HFQ3858 )

Refusal

BOX HFKE1 - (HFQ3858 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:17 PM Thursday, March 28, 2013

Page 563 of 789

HFKD4

HFKD4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRMEAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2270

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:21:17 PM Thursday, March 28, 2013

Page 564 of 789

HFKD4
Question Text:

You mentioned that [you receive/(SP) receives] help with preparing
(your/his/her) own meals. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRMEAL

( HFQ3852 )

HLPR.HLPRMEAL

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFKE1 - (HFQ3858 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:21:18 PM Thursday, March 28, 2013

Page 565 of 789

HFKD4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

Set HLPR.HLPRMEAL = 1/Indicated.

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:21:18 PM Thursday, March 28, 2013

Page 566 of 789

HFKD4
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:18 PM Thursday, March 28, 2013

Page 567 of 789

BOX HFKE1

BOX HFKE1

Page Order # :

2275

BOX INSTRUCTIONS
( HFQ3858 )

IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO
HFKE3 - HELPSHOP ( HFQ3860 ).
ELSE GO TO BOX HFKF1 - (HFQ3868 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:18 PM Thursday, March 28, 2013

Page 568 of 789

HFKE3

HFKE3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPSHOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2280

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFKE1 - PRBSHOP = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(such as...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

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

4:21:19 PM Thursday, March 28, 2013

[[You said that [your/(SP's)] health makes shopping for personal
items (such as toilet items or medicines) difficult./You said that
shopping for personal items (such as toilet items or medicines) is
something that [you don't do/(SP) doesn't do].]]
Page 569 of 789

HFKE3
[Do you/Does (SP)] receive help from another person with...
shopping for personal items (such as toilet items or medicines)?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

HELPSHOP

Cheshire Name:

( HFQ3860 )

IADL.HELPSHOP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKE4 - PERSON_HLPRSHOP ( HFQ3862 )

English text: YES
No

BOX HFKF1 - (HFQ3868 )

English text: NO
Attribute
Don't know

Route
BOX HFKF1 - (HFQ3868 )

Refusal

BOX HFKF1 - (HFQ3868 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:21:20 PM Thursday, March 28, 2013

Page 570 of 789

HFKE3
DESIGN NOTES

4:21:20 PM Thursday, March 28, 2013

Page 571 of 789

HFKE4

HFKE4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRSHOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2285

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(such as...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:21:20 PM Thursday, March 28, 2013

Page 572 of 789

HFKE4
Question Text:

You mentioned that [you receive/(SP) receives] help with shopping
for personal items (such as toilet items or medicines). Who gives
that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRSHOP

( HFQ3862 )

HLPR.HLPRSHOP

Item Text display:

Item Text:

Label:

Label Position:

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

String

TRostPick8
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

8

Route
BOX HFKF1 - (HFQ3868 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

4:21:21 PM Thursday, March 28, 2013

Page 573 of 789

HFKE4
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

Set HLPR.HLPRSHOP = 1/Indicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

4:21:21 PM Thursday, March 28, 2013

Page 574 of 789

HFKE4
HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:21 PM Thursday, March 28, 2013

Page 575 of 789

BOX HFKF1

BOX HFKF1

Page Order # :

2290

BOX INSTRUCTIONS
( HFQ3868 )

IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO
HFKF3 - HELPBILS ( HFQ3870 ).
ELSE GO TO HFLINTRO - ADLSINTRO ( HFQ3950 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:21 PM Thursday, March 28, 2013

Page 576 of 789

HFKF3

HFKF3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPBILS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2295

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFKF1 - PRBBILS = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like keeping track...)" in parenthesis.
Always display "[You said…]" in brackets.

Multi Field display:

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

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

4:21:22 PM Thursday, March 28, 2013

[[You said that [your/(SP's)] health makes managing money (like
keeping track of expenses or paying bills) difficult./You said that
managing money (like keeping track of expenses or paying bills) is
something that [you don't do/(SP) doesn't do].]]
Page 577 of 789

HFKF3
[Do you/Does (SP)] receive help from another person with...
managing money (like keeping track of expenses or paying bills)?
Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

HELPBILS

Cheshire Name:

( HFQ3870 )

IADL.HELPBILS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKF4 - PERSON_HLPRBILS ( HFQ3872 )

English text: YES
No

HFLINTRO - ADLSINTRO ( HFQ3950 )

English text: NO
Attribute
Don't know

Route
HFLINTRO - ADLSINTRO ( HFQ3950 )

Refusal

HFLINTRO - ADLSINTRO ( HFQ3950 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:21:23 PM Thursday, March 28, 2013

Page 578 of 789

HFKF3
DESIGN NOTES

4:21:23 PM Thursday, March 28, 2013

Page 579 of 789

HFKF4

HFKF4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRBILS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2300

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Always display "(like keeping track...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:21:24 PM Thursday, March 28, 2013

Page 580 of 789

HFKF4
Question Text:

You mentioned that [you receive/(SP) receives] help with managing
money (like keeping track of expenses or paying bills). Who gives
that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRBILS

( HFQ3872 )

HLPR.HLPRBILS

Item Text display:

Item Text:

Label:

Label Position:

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

String

TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
HFLINTRO - ADLSINTRO ( HFQ3950 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

4:21:24 PM Thursday, March 28, 2013

Page 581 of 789

HFKF4
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

Set HLPR.HLPRBILS = 1/Indicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

4:21:24 PM Thursday, March 28, 2013

Page 582 of 789

HFKF4
HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:24 PM Thursday, March 28, 2013

Page 583 of 789

HFLINTRO

HFLINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

ADLSINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2305

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "by (yourself/himself/herself)" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Now I'll ask about some other everyday activities. I'd like to know
whether [you have/(SP) has] any difficulty doing each one by
(yourself/himself/herself) and without special equipment.

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:25 PM Thursday, March 28, 2013

Page 584 of 789

HFLINTRO

Field1:

ADLSINTRO

Cheshire Name:

( HFQ3950 )

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
HFLA1 - HPPDBATH ( HFQ3960 )

English text: CONTINUE
Attribute

Route

Empty

HFLA1 - HPPDBATH ( HFQ3960 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:26 PM Thursday, March 28, 2013

Page 585 of 789

HFLA1

HFLA1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HPPDBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2310

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
bathing or showering?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:27 PM Thursday, March 28, 2013

Page 586 of 789

HFLA1

Field1:

HPPDBATH

Cheshire Name:

( HFQ3960 )

ADLS.HPPDBATH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB1 - HPPDDRES ( HFQ3970 )

2

English text: YES
No

HFLB1 - HPPDDRES ( HFQ3970 )

3

English text: NO
DoesntDo

HFLA2 - DONTBATH ( HFQ3962 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLB1 - HPPDDRES ( HFQ3970 )

Refusal

HFLB1 - HPPDDRES ( HFQ3970 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:28 PM Thursday, March 28, 2013

Page 587 of 789

HFLA2

HFLA2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2315

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that bathing or showering is something that [you don't/(SP)

doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:28 PM Thursday, March 28, 2013

Page 588 of 789

HFLA2

Field1:

DONTBATH

Cheshire Name:

( HFQ3962 )

ADLS.DONTBATH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB1 - HPPDDRES ( HFQ3970 )

English text: YES
No

HFLB1 - HPPDDRES ( HFQ3970 )

English text: NO
Attribute

Route

Don't know

HFLB1 - HPPDDRES ( HFQ3970 )

Refusal

HFLB1 - HPPDDRES ( HFQ3970 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:29 PM Thursday, March 28, 2013

Page 589 of 789

HFLB1

HFLB1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HPPDDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2320

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
dressing?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:30 PM Thursday, March 28, 2013

Page 590 of 789

HFLB1

Field1:

HPPDDRES

Cheshire Name:

( HFQ3970 )

ADLS.HPPDDRES

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC1 - HPPDEAT ( HFQ3980 )

2

English text: YES
No

HFLC1 - HPPDEAT ( HFQ3980 )

3

English text: NO
DoesntDo

HFLB2 - DONTDRES ( HFQ3972 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLC1 - HPPDEAT ( HFQ3980 )

Refusal

HFLC1 - HPPDEAT ( HFQ3980 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:31 PM Thursday, March 28, 2013

Page 591 of 789

HFLB2

HFLB2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2325

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that dressing is something that [you don't/(SP) doesn't]

do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:32 PM Thursday, March 28, 2013

Page 592 of 789

HFLB2

Field1:

DONTDRES

Cheshire Name:

( HFQ3972 )

ADLS.DONTDRES

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC1 - HPPDEAT ( HFQ3980 )

English text: YES
No

HFLC1 - HPPDEAT ( HFQ3980 )

English text: NO
Attribute

Route

Don't know

HFLC1 - HPPDEAT ( HFQ3980 )

Refusal

HFLC1 - HPPDEAT ( HFQ3980 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:33 PM Thursday, March 28, 2013

Page 593 of 789

HFLC1

HFLC1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HPPDEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2330

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
eating?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:34 PM Thursday, March 28, 2013

Page 594 of 789

HFLC1

Field1:

HPPDEAT

Cheshire Name:

( HFQ3980 )

ADLS.HPPDEAT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

2

English text: YES
No

HFLD1 - HPPDCHAR ( HFQ3990 )

3

English text: NO
DoesntDo

HFLC2 - DONTEAT ( HFQ3982 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

Refusal

HFLD1 - HPPDCHAR ( HFQ3990 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:35 PM Thursday, March 28, 2013

Page 595 of 789

HFLC2

HFLC2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2335

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that eating is something that [you don't/(SP) doesn't] do.]

Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:36 PM Thursday, March 28, 2013

Page 596 of 789

HFLC2

Field1:

DONTEAT

Cheshire Name:

( HFQ3982 )

ADLS.DONTEAT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

English text: YES
No

HFLD1 - HPPDCHAR ( HFQ3990 )

English text: NO
Attribute

Route

Don't know

HFLD1 - HPPDCHAR ( HFQ3990 )

Refusal

HFLD1 - HPPDCHAR ( HFQ3990 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:37 PM Thursday, March 28, 2013

Page 597 of 789

HFLD1

HFLD1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HPPDCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2340

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
getting in or out of bed or chairs?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:38 PM Thursday, March 28, 2013

Page 598 of 789

HFLD1

Field1:

HPPDCHAR

Cheshire Name:

( HFQ3990 )

ADLS.HPPDCHAR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE1 - HPPDWALK ( HFQ4000 )

2

English text: YES
No

HFLE1 - HPPDWALK ( HFQ4000 )

3

English text: NO
DoesntDo

HFLD2 - DONTCHAR ( HFQ3992 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLE1 - HPPDWALK ( HFQ4000 )

Refusal

HFLE1 - HPPDWALK ( HFQ4000 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:39 PM Thursday, March 28, 2013

Page 599 of 789

HFLD2

HFLD2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2345

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that getting in or out of bed or chairs is something that [you

don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:39 PM Thursday, March 28, 2013

Page 600 of 789

HFLD2

Field1:

DONTCHAR

Cheshire Name:

( HFQ3992 )

ADLS.DONTCHAR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE1 - HPPDWALK ( HFQ4000 )

English text: YES
No

HFLE1 - HPPDWALK ( HFQ4000 )

English text: NO
Attribute

Route

Don't know

HFLE1 - HPPDWALK ( HFQ4000 )

Refusal

HFLE1 - HPPDWALK ( HFQ4000 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:40 PM Thursday, March 28, 2013

Page 601 of 789

HFLE1

HFLE1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HPPDWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2350

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
walking?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:41 PM Thursday, March 28, 2013

Page 602 of 789

HFLE1

Field1:

HPPDWALK

Cheshire Name:

( HFQ4000 )

ADLS.HPPDWALK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

2

English text: YES
No

HFLF1 - HPPDTOIL ( HFQ4010 )

3

English text: NO
DoesntDo

HFLE2 - DONTWALK ( HFQ4002 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

Refusal

HFLF1 - HPPDTOIL ( HFQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:42 PM Thursday, March 28, 2013

Page 603 of 789

HFLE2

HFLE2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DONTWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2355

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that walking is something that [you don't/(SP) doesn't] do.]

Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:43 PM Thursday, March 28, 2013

Page 604 of 789

HFLE2

Field1:

DONTWALK

Cheshire Name:

( HFQ4002 )

ADLS.DONTWALK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

English text: YES
No

HFLF1 - HPPDTOIL ( HFQ4010 )

English text: NO
Attribute

Route

Don't know

HFLF1 - HPPDTOIL ( HFQ4010 )

Refusal

HFLF1 - HPPDTOIL ( HFQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:44 PM Thursday, March 28, 2013

Page 605 of 789

HFLF1

HFLF1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HPPDTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2360

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "any" in BOLD.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
using the toilet?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:45 PM Thursday, March 28, 2013

Page 606 of 789

HFLF1

Field1:

HPPDTOIL

Cheshire Name:

( HFQ4010 )

ADLS.HPPDTOIL

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

Enumerated
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA1 - (HFQ4080 )

2

English text: YES
No

BOX HFLA1 - (HFQ4080 )

3

English text: NO
DoesntDo

HFLF2 - DONTTOIL ( HFQ4012 )

English text: DOESN'T DO
Attribute
Don't know

Route
BOX HFLA1 - (HFQ4080 )

Refusal

BOX HFLA1 - (HFQ4080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:46 PM Thursday, March 28, 2013

Page 607 of 789

HFLF2

HFLF2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DONTTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2365

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that using the toilet is something that [you don't/(SP)

doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:47 PM Thursday, March 28, 2013

Page 608 of 789

HFLF2

Field1:

DONTTOIL

Cheshire Name:

( HFQ4012 )

ADLS.DONTTOIL

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA1 - (HFQ4080 )

English text: YES
No

BOX HFLA1 - (HFQ4080 )

English text: NO
Attribute

Route

Don't know

BOX HFLA1 - (HFQ4080 )

Refusal

BOX HFLA1 - (HFQ4080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:48 PM Thursday, March 28, 2013

Page 609 of 789

BOX HFLA1

BOX HFLA1

Page Order # :

2370

BOX INSTRUCTIONS
( HFQ4080 )

IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO
HFLA3 - HELPBATH ( HFQ4081 ).
ELSE GO TO BOX HFLB1 - (HFQ4090 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:48 PM Thursday, March 28, 2013

Page 610 of 789

HFLA3

HFLA3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2375

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFLA1 - HPPDBATH = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[[You said [your/(SP's)] health makes bathing or showering
difficult./You said that bathing or showering is something [you
don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or
showering?

4:21:48 PM Thursday, March 28, 2013

Page 611 of 789

HFLA3
Int. Instr II:

INPUT FIELDS / ROUTING

HELPBATH

Field1:
Cheshire Name:

( HFQ4081 )

ADLS.HELPBATH

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLA5 - EQIPBATH ( HFQ4083 )

English text: YES
No

HFLA4 - PCHKBATH ( HFQ4082 )

English text: NO
Attribute

Route

Don't know

HFLA4 - PCHKBATH ( HFQ4082 )

Refusal

HFLA4 - PCHKBATH ( HFQ4082 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:49 PM Thursday, March 28, 2013

Page 612 of 789

HFLA4

HFLA4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PCHKBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2380

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[That is, does...]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with bathing or showering?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:50 PM Thursday, March 28, 2013

Page 613 of 789

HFLA4

Field1:

PCHKBATH

Cheshire Name:

( HFQ4082 )

ADLS.PCHKBATH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLA5 - EQIPBATH ( HFQ4083 )

English text: YES
No

HFLA5 - EQIPBATH ( HFQ4083 )

English text: NO
Attribute

Route

Don't know

HFLA5 - EQIPBATH ( HFQ4083 )

Refusal

HFLA5 - EQIPBATH ( HFQ4083 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:51 PM Thursday, March 28, 2013

Page 614 of 789

HFLA5

HFLA5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2385

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with bathing or showering?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:52 PM Thursday, March 28, 2013

Page 615 of 789

HFLA5

Field1:

EQIPBATH

Cheshire Name:

( HFQ4083 )

ADLS.EQIPBATH

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA2 - (HFQ4085 )

English text: YES
No

BOX HFLA2 - (HFQ4085 )

English text: NO
Attribute

Route

Don't know

BOX HFLA2 - (HFQ4085 )

Refusal

BOX HFLA2 - (HFQ4085 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:53 PM Thursday, March 28, 2013

Page 616 of 789

BOX HFLA2

BOX HFLA2

Page Order # :

2390

BOX INSTRUCTIONS
( HFQ4085 )

IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH ( HFQ4086 ).
ELSE GO TO BOX HFLB1 - (HFQ4090 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:53 PM Thursday, March 28, 2013

Page 617 of 789

HFLA6

HFLA6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2395

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with bathing or
showering? Has it been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:54 PM Thursday, March 28, 2013

Page 618 of 789

HFLA6

Field1:

LONGBATH

Cheshire Name:

( HFQ4086 )

ADLS.LONGBATH

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLA7 - STILBATH ( HFQ4088 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLB1 - (HFQ4090 )

BOX HFLB1 - (HFQ4090 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLB1 - (HFQ4090 )

Refusal

BOX HFLB1 - (HFQ4090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:55 PM Thursday, March 28, 2013

Page 619 of 789

HFLA7

HFLA7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2400

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you expect that [you/(SP)] will still need help with bathing or
showering three months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:21:55 PM Thursday, March 28, 2013

Page 620 of 789

HFLA7

Field1:

STILBATH

Cheshire Name:

( HFQ4088 )

ADLS.STILBATH

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLB1 - (HFQ4090 )

English text: YES
No

BOX HFLB1 - (HFQ4090 )

English text: NO
Attribute

Route

Don't know

BOX HFLB1 - (HFQ4090 )

Refusal

BOX HFLB1 - (HFQ4090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:56 PM Thursday, March 28, 2013

Page 621 of 789

BOX HFLB1

BOX HFLB1

Page Order # :

2405

BOX INSTRUCTIONS
( HFQ4090 )

IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO
HFLB3 - HELPDRES ( HFQ4091 ).
ELSE GO TO BOX HFLC1 - (HFQ4100 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:21:56 PM Thursday, March 28, 2013

Page 622 of 789

HFLB3

HFLB3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2410

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFLB1 - HPPDDRES = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[You said [your/(SP's)] health makes dressing difficult./You said that

dressing is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with dressing?

Int. Instr II:
4:21:57 PM Thursday, March 28, 2013

Page 623 of 789

HFLB3
INPUT FIELDS / ROUTING
HELPDRES

Field1:
Cheshire Name:

( HFQ4091 )

ADLS.HELPDRES

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB5 - EQIPDRES ( HFQ4093 )

English text: YES
No

HFLB4 - PCHKDRES ( HFQ4092 )

English text: NO
Attribute
Don't know

Route
HFLB4 - PCHKDRES ( HFQ4092 )

Refusal

HFLB4 - PCHKDRES ( HFQ4092 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:21:58 PM Thursday, March 28, 2013

Page 624 of 789

HFLB4

HFLB4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PCHKDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2415

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[That is, does...]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with dressing?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:21:59 PM Thursday, March 28, 2013

Page 625 of 789

HFLB4

Field1:

PCHKDRES

Cheshire Name:

( HFQ4092 )

ADLS.PCHKDRES

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB5 - EQIPDRES ( HFQ4093 )

English text: YES
No

HFLB5 - EQIPDRES ( HFQ4093 )

English text: NO
Attribute

Route

Don't know

HFLB5 - EQIPDRES ( HFQ4093 )

Refusal

HFLB5 - EQIPDRES ( HFQ4093 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:00 PM Thursday, March 28, 2013

Page 626 of 789

HFLB5

HFLB5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2420

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with dressing?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:01 PM Thursday, March 28, 2013

Page 627 of 789

HFLB5

Field1:

EQIPDRES

Cheshire Name:

( HFQ4093 )

ADLS.EQIPDRES

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLB2 - (HFQ4095 )

English text: YES
No

BOX HFLB2 - (HFQ4095 )

English text: NO
Attribute

Route

Don't know

BOX HFLB2 - (HFQ4095 )

Refusal

BOX HFLB2 - (HFQ4095 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:02 PM Thursday, March 28, 2013

Page 628 of 789

BOX HFLB2

BOX HFLB2

Page Order # :

2425

BOX INSTRUCTIONS
( HFQ4095 )

IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES ( HFQ4096 ).
ELSE GO TO BOX HFLC1 - (HFQ4100 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:02 PM Thursday, March 28, 2013

Page 629 of 789

HFLB6

HFLB6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2430

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with dressing? Has it
been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:03 PM Thursday, March 28, 2013

Page 630 of 789

HFLB6

Field1:

LONGDRES

Cheshire Name:

( HFQ4096 )

ADLS.LONGDRES

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB7 - STILDRES ( HFQ4098 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLC1 - (HFQ4100 )

BOX HFLC1 - (HFQ4100 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLC1 - (HFQ4100 )

Refusal

BOX HFLC1 - (HFQ4100 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:04 PM Thursday, March 28, 2013

Page 631 of 789

HFLB7

HFLB7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2435

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you expect that [you/(SP)] will still need help with dressing three
months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:04 PM Thursday, March 28, 2013

Page 632 of 789

HFLB7

Field1:

STILDRES

Cheshire Name:

( HFQ4098 )

ADLS.STILDRES

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLC1 - (HFQ4100 )

English text: YES
No

BOX HFLC1 - (HFQ4100 )

English text: NO
Attribute

Route

Don't know

BOX HFLC1 - (HFQ4100 )

Refusal

BOX HFLC1 - (HFQ4100 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:05 PM Thursday, March 28, 2013

Page 633 of 789

BOX HFLC1

BOX HFLC1

Page Order # :

2440

BOX INSTRUCTIONS
( HFQ4100 )

IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO
HFLC3 - HELPEAT ( HFQ4101 ).
ELSE GO TO BOX HFLD1 - (HFQ4110 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:05 PM Thursday, March 28, 2013

Page 634 of 789

HFLC3

HFLC3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2445

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFLC1 - HPPDEAT = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[You said [your/(SP's)] health makes eating difficult./You said that

eating is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with eating?

Int. Instr II:
4:22:06 PM Thursday, March 28, 2013

Page 635 of 789

HFLC3
INPUT FIELDS / ROUTING
HELPEAT

Field1:
Cheshire Name:

( HFQ4101 )

ADLS.HELPEAT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC5 - EQIPEAT ( HFQ4103 )

English text: YES
No

HFLC4 - PCHKEAT ( HFQ4102 )

English text: NO
Attribute
Don't know

Route
HFLC4 - PCHKEAT ( HFQ4102 )

Refusal

HFLC4 - PCHKEAT ( HFQ4102 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:07 PM Thursday, March 28, 2013

Page 636 of 789

HFLC4

HFLC4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PCHKEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2450

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[That is, does...]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with eating?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:22:08 PM Thursday, March 28, 2013

Page 637 of 789

HFLC4

Field1:

PCHKEAT

Cheshire Name:

( HFQ4102 )

ADLS.PCHKEAT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC5 - EQIPEAT ( HFQ4103 )

English text: YES
No

HFLC5 - EQIPEAT ( HFQ4103 )

English text: NO
Attribute

Route

Don't know

HFLC5 - EQIPEAT ( HFQ4103 )

Refusal

HFLC5 - EQIPEAT ( HFQ4103 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:09 PM Thursday, March 28, 2013

Page 638 of 789

HFLC5

HFLC5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2455

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with eating?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:10 PM Thursday, March 28, 2013

Page 639 of 789

HFLC5

Field1:

EQIPEAT

Cheshire Name:

( HFQ4103 )

ADLS.EQIPEAT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLC2 - (HFQ4105 )

English text: YES
No

BOX HFLC2 - (HFQ4105 )

English text: NO
Attribute

Route

Don't know

BOX HFLC2 - (HFQ4105 )

Refusal

BOX HFLC2 - (HFQ4105 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:11 PM Thursday, March 28, 2013

Page 640 of 789

BOX HFLC2

BOX HFLC2

Page Order # :

2460

BOX INSTRUCTIONS
( HFQ4105 )

IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT ( HFQ4106 ).
ELSE GO TO BOX HFLD1 - (HFQ4110 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:11 PM Thursday, March 28, 2013

Page 641 of 789

HFLC6

HFLC6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2465

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with eating? Has it been .
..

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:11 PM Thursday, March 28, 2013

Page 642 of 789

HFLC6

Field1:

LONGEAT

Cheshire Name:

( HFQ4106 )

ADLS.LONGEAT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC7 - STILEAT ( HFQ4108 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLD1 - (HFQ4110 )

BOX HFLD1 - (HFQ4110 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLD1 - (HFQ4110 )

Refusal

BOX HFLD1 - (HFQ4110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:12 PM Thursday, March 28, 2013

Page 643 of 789

HFLC7

HFLC7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2470

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you expect that [you/(SP)] will still need help with eating three
months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:13 PM Thursday, March 28, 2013

Page 644 of 789

HFLC7

Field1:

STILEAT

Cheshire Name:

( HFQ4108 )

ADLS.STILEAT

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLD1 - (HFQ4110 )

English text: YES
No

BOX HFLD1 - (HFQ4110 )

English text: NO
Attribute

Route

Don't know

BOX HFLD1 - (HFQ4110 )

Refusal

BOX HFLD1 - (HFQ4110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:14 PM Thursday, March 28, 2013

Page 645 of 789

BOX HFLD1

BOX HFLD1

Page Order # :

2475

BOX INSTRUCTIONS
( HFQ4110 )

IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO
HFLD3 - HELPCHAR ( HFQ4111 ).
ELSE GO TO BOX HFLE1 - (HFQ4120 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:14 PM Thursday, March 28, 2013

Page 646 of 789

HFLD3

HFLD3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2480

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFLD1 - HPPDCHAR = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[[You said [your/(SP's)] health makes getting in or out of bed or
chairs difficult./You said that getting in or out of bed or chairs is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with getting in
or out of bed or chairs?

4:22:15 PM Thursday, March 28, 2013

Page 647 of 789

HFLD3
Int. Instr II:

INPUT FIELDS / ROUTING

HELPCHAR

Field1:
Cheshire Name:

( HFQ4111 )

ADLS.HELPCHAR

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD5 - EQIPCHAR ( HFQ4113 )

English text: YES
No

HFLD4 - PCHKCHAR ( HFQ4112 )

English text: NO
Attribute

Route

Don't know

HFLD4 - PCHKCHAR ( HFQ4112 )

Refusal

HFLD4 - PCHKCHAR ( HFQ4112 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:16 PM Thursday, March 28, 2013

Page 648 of 789

HFLD4

HFLD4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PCHKCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2485

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[That is, does...]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with getting in or out of bed or chairs?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:22:17 PM Thursday, March 28, 2013

Page 649 of 789

HFLD4

Field1:

PCHKCHAR

Cheshire Name:

( HFQ4112 )

ADLS.PCHKCHAR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD5 - EQIPCHAR ( HFQ4113 )

English text: YES
No

HFLD5 - EQIPCHAR ( HFQ4113 )

English text: NO
Attribute

Route

Don't know

HFLD5 - EQIPCHAR ( HFQ4113 )

Refusal

HFLD5 - EQIPCHAR ( HFQ4113 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:18 PM Thursday, March 28, 2013

Page 650 of 789

HFLD5

HFLD5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2490

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with getting in or out of bed or chairs?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:18 PM Thursday, March 28, 2013

Page 651 of 789

HFLD5

Field1:

EQIPCHAR

Cheshire Name:

( HFQ4113 )

ADLS.EQIPCHAR

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLD2 - (HFQ4115 )

English text: YES
No

BOX HFLD2 - (HFQ4115 )

English text: NO
Attribute

Route

Don't know

BOX HFLD2 - (HFQ4115 )

Refusal

BOX HFLD2 - (HFQ4115 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:19 PM Thursday, March 28, 2013

Page 652 of 789

BOX HFLD2

BOX HFLD2

Page Order # :

2495

BOX INSTRUCTIONS
( HFQ4115 )

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR ( HFQ4116 ).
ELSE GO TO BOX HFLE1 - (HFQ4120 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:19 PM Thursday, March 28, 2013

Page 653 of 789

HFLD6

HFLD6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2500

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with getting in or out of
bed or chairs? Has it been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:20 PM Thursday, March 28, 2013

Page 654 of 789

HFLD6

Field1:

LONGCHAR

Cheshire Name:

( HFQ4116 )

ADLS.LONGCHAR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD7 - STILCHAR ( HFQ4118 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLE1 - (HFQ4120 )

BOX HFLE1 - (HFQ4120 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLE1 - (HFQ4120 )

Refusal

BOX HFLE1 - (HFQ4120 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:21 PM Thursday, March 28, 2013

Page 655 of 789

HFLD7

HFLD7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2505

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you expect that [you/(SP)] will still need help with getting in or out
of bed or chairs three months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:22 PM Thursday, March 28, 2013

Page 656 of 789

HFLD7

Field1:

STILCHAR

Cheshire Name:

( HFQ4118 )

ADLS.STILCHAR

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLE1 - (HFQ4120 )

English text: YES
No

BOX HFLE1 - (HFQ4120 )

English text: NO
Attribute

Route

Don't know

BOX HFLE1 - (HFQ4120 )

Refusal

BOX HFLE1 - (HFQ4120 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:23 PM Thursday, March 28, 2013

Page 657 of 789

BOX HFLE1

BOX HFLE1

Page Order # :

2510

BOX INSTRUCTIONS
( HFQ4120 )

IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTW ALK = 1/Yes, GO TO
HFLE3 - HELPW ALK ( HFQ4121 ).
ELSE GO TO BOX HFLF1 - (HFQ4130 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:23 PM Thursday, March 28, 2013

Page 658 of 789

HFLE3

HFLE3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2515

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFLE1 - HPPDWALK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[[You said [your/(SP's)] health makes walking difficult./You said that
walking is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with walking?

Int. Instr II:
4:22:24 PM Thursday, March 28, 2013

Page 659 of 789

HFLE3
INPUT FIELDS / ROUTING
HELPWALK

Field1:
Cheshire Name:

( HFQ4121 )

ADLS.HELPWALK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE5 - EQIPWALK ( HFQ4123 )

English text: YES
No

HFLE4 - PCHKWALK ( HFQ4122 )

English text: NO
Attribute
Don't know

Route
HFLE4 - PCHKWALK ( HFQ4122 )

Refusal

HFLE4 - PCHKWALK ( HFQ4122 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:25 PM Thursday, March 28, 2013

Page 660 of 789

HFLE4

HFLE4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PCHKWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2520

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[That is, does...]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with walking?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:22:25 PM Thursday, March 28, 2013

Page 661 of 789

HFLE4

Field1:

PCHKWALK

Cheshire Name:

( HFQ4122 )

ADLS.PCHKWALK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE5 - EQIPWALK ( HFQ4123 )

English text: YES
No

HFLE5 - EQIPWALK ( HFQ4123 )

English text: NO
Attribute

Route

Don't know

HFLE5 - EQIPWALK ( HFQ4123 )

Refusal

HFLE5 - EQIPWALK ( HFQ4123 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:26 PM Thursday, March 28, 2013

Page 662 of 789

HFLE5

HFLE5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2525

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with walking?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:27 PM Thursday, March 28, 2013

Page 663 of 789

HFLE5

Field1:

EQIPWALK

Cheshire Name:

( HFQ4123 )

ADLS.EQIPWALK

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLE2 - (HFQ4125 )

English text: YES
No

BOX HFLE2 - (HFQ4125 )

English text: NO
Attribute

Route

Don't know

BOX HFLE2 - (HFQ4125 )

Refusal

BOX HFLE2 - (HFQ4125 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:28 PM Thursday, March 28, 2013

Page 664 of 789

BOX HFLE2

BOX HFLE2

Page Order # :

2530

BOX INSTRUCTIONS
( HFQ4125 )

IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK ( HFQ4126 ).
ELSE GO TO BOX HFLF1 - (HFQ4130 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:28 PM Thursday, March 28, 2013

Page 665 of 789

HFLE6

HFLE6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2535

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with walking? Has it been
...

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:29 PM Thursday, March 28, 2013

Page 666 of 789

HFLE6

Field1:

LONGWALK

Cheshire Name:

( HFQ4126 )

ADLS.LONGWALK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE7 - STILWALK ( HFQ4128 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLF1 - (HFQ4130 )

BOX HFLF1 - (HFQ4130 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLF1 - (HFQ4130 )

Refusal

BOX HFLF1 - (HFQ4130 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:30 PM Thursday, March 28, 2013

Page 667 of 789

HFLE7

HFLE7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2540

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you expect that [you/(SP)] will still need help with walking three
months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:30 PM Thursday, March 28, 2013

Page 668 of 789

HFLE7

Field1:

STILWALK

Cheshire Name:

( HFQ4128 )

ADLS.STILWALK

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLF1 - (HFQ4130 )

English text: YES
No

BOX HFLF1 - (HFQ4130 )

English text: NO
Attribute

Route

Don't know

BOX HFLF1 - (HFQ4130 )

Refusal

BOX HFLF1 - (HFQ4130 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:31 PM Thursday, March 28, 2013

Page 669 of 789

BOX HFLF1

BOX HFLF1

Page Order # :

2545

BOX INSTRUCTIONS
( HFQ4130 )

IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO
HFLF3 - HELPTOIL ( HFQ4131 ).
ELSE GO TO BOX HFLA3 - (HFQ4400 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:31 PM Thursday, March 28, 2013

Page 670 of 789

HFLF3

HFLF3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2550

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFLF1 - HPPDTOIL = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

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

[[You said [your/(SP's)] health makes using the toilet difficult./You
said that using the toilet is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with using the
toilet?

4:22:32 PM Thursday, March 28, 2013

Page 671 of 789

HFLF3
Int. Instr II:

INPUT FIELDS / ROUTING

HELPTOIL

Field1:
Cheshire Name:

( HFQ4131 )

ADLS.HELPTOIL

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF5 - EQIPTOIL ( HFQ4133 )

English text: YES
No

HFLF4 - PCHKTOIL ( HFQ4132 )

English text: NO
Attribute

Route

Don't know

HFLF4 - PCHKTOIL ( HFQ4132 )

Refusal

HFLF4 - PCHKTOIL ( HFQ4132 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:33 PM Thursday, March 28, 2013

Page 672 of 789

HFLF4

HFLF4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PCHKTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2555

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[That is, does...]" in brackets.

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with using the toilet?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING

4:22:34 PM Thursday, March 28, 2013

Page 673 of 789

HFLF4

Field1:

PCHKTOIL

Cheshire Name:

( HFQ4132 )

ADLS.PCHKTOIL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF5 - EQIPTOIL ( HFQ4133 )

English text: YES
No

HFLF5 - EQIPTOIL ( HFQ4133 )

English text: NO
Attribute

Route

Don't know

HFLF5 - EQIPTOIL ( HFQ4133 )

Refusal

HFLF5 - EQIPTOIL ( HFQ4133 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:35 PM Thursday, March 28, 2013

Page 674 of 789

HFLF5

HFLF5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2560

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with using the toilet?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:36 PM Thursday, March 28, 2013

Page 675 of 789

HFLF5

Field1:

EQIPTOIL

Cheshire Name:

( HFQ4133 )

ADLS.EQIPTOIL

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLF2 - (HFQ4135 )

English text: YES
No

BOX HFLF2 - (HFQ4135 )

English text: NO
Attribute

Route

Don't know

BOX HFLF2 - (HFQ4135 )

Refusal

BOX HFLF2 - (HFQ4135 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:37 PM Thursday, March 28, 2013

Page 676 of 789

BOX HFLF2

BOX HFLF2

Page Order # :

2565

BOX INSTRUCTIONS
( HFQ4135 )

IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL ( HFQ4136 ).
ELSE GO TO BOX HFLA3 - (HFQ4400 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:37 PM Thursday, March 28, 2013

Page 677 of 789

HFLF6

HFLF6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2570

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with using the toilet? Has
it been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:38 PM Thursday, March 28, 2013

Page 678 of 789

HFLF6

Field1:

LONGTOIL

Cheshire Name:

( HFQ4136 )

ADLS.LONGTOIL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF7 - STILTOIL ( HFQ4138 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLA3 - (HFQ4400 )

BOX HFLA3 - (HFQ4400 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLA3 - (HFQ4400 )

Refusal

BOX HFLA3 - (HFQ4400 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:39 PM Thursday, March 28, 2013

Page 679 of 789

HFLF7

HFLF7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2575

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Do you expect that [you/(SP)] will still need help with using the toilet
three months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:39 PM Thursday, March 28, 2013

Page 680 of 789

HFLF7

Field1:

STILTOIL

Cheshire Name:

( HFQ4138 )

ADLS.STILTOIL

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA3 - (HFQ4400 )

English text: YES
No

BOX HFLA3 - (HFQ4400 )

English text: NO
Attribute

Route

Don't know

BOX HFLA3 - (HFQ4400 )

Refusal

BOX HFLA3 - (HFQ4400 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:40 PM Thursday, March 28, 2013

Page 681 of 789

BOX HFLA3

BOX HFLA3

Page Order # :

2580

BOX INSTRUCTIONS
( HFQ4400 )

IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH (
HFQ4405 ).
ELSE GO TO BOX HFLB3 - (HFQ4410 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:40 PM Thursday, March 28, 2013

Page 682 of 789

HFLA9

HFLA9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2585

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:22:41 PM Thursday, March 28, 2013

Page 683 of 789

HFLA9
Question Text:

You mentioned that [you receive/(SP) receives] help with bathing
and showering. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRBATH

( HFQ4405 )

TEMP

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFLB3 - (HFQ4410 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:22:41 PM Thursday, March 28, 2013

Page 684 of 789

HFLA9
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

Set HLPR.HLPRBATH = 1/Indicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:22:41 PM Thursday, March 28, 2013

Page 685 of 789

HFLA9
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:41 PM Thursday, March 28, 2013

Page 686 of 789

BOX HFLB3

BOX HFLB3

Page Order # :

2590

BOX INSTRUCTIONS
( HFQ4410 )

IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES (
HFQ4415 ).
ELSE GO TO BOX HFLC3 - (HFQ4420 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:41 PM Thursday, March 28, 2013

Page 687 of 789

HFLB9

HFLB9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2595

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:22:42 PM Thursday, March 28, 2013

Page 688 of 789

HFLB9
Question Text:

You mentioned that [you receive/(SP) receives] help with dressing.
Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRDRES

( HFQ4415 )

TEMP

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFLC3 - (HFQ4420 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:22:42 PM Thursday, March 28, 2013

Page 689 of 789

HFLB9
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

Set HLPR.HLPRDRES = 1/Indicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:22:42 PM Thursday, March 28, 2013

Page 690 of 789

HFLB9
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:42 PM Thursday, March 28, 2013

Page 691 of 789

BOX HFLC3

BOX HFLC3

Page Order # :

2600

BOX INSTRUCTIONS
( HFQ4420 )

IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT (
HFQ4425 ).
ELSE GO TO BOX HFLD3 - (HFQ4430 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:42 PM Thursday, March 28, 2013

Page 692 of 789

HFLC9

HFLC9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPREAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2605

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:22:43 PM Thursday, March 28, 2013

Page 693 of 789

HFLC9
Question Text:

You mentioned that [you receive/(SP) receives] help with eating.
Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPREAT

( HFQ4425 )

TEMP

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFLD3 - (HFQ4430 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:22:44 PM Thursday, March 28, 2013

Page 694 of 789

HFLC9
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

Set HLPR.HLPREAT = 1/Indicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:22:44 PM Thursday, March 28, 2013

Page 695 of 789

HFLC9
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:44 PM Thursday, March 28, 2013

Page 696 of 789

BOX HFLD3

BOX HFLD3

Page Order # :

2610

BOX INSTRUCTIONS
( HFQ4430 )

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR (
HFQ4435 ).
ELSE GO TO BOX HFLE3 - (HFQ4440 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:44 PM Thursday, March 28, 2013

Page 697 of 789

HFLD9

HFLD9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2615

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:22:44 PM Thursday, March 28, 2013

Page 698 of 789

HFLD9
Question Text:

You mentioned that [you receive/(SP) receives] help with getting in
or out of bed or chairs. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRCHAR ( HFQ4435 )

TEMP

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFLE3 - (HFQ4440 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:22:45 PM Thursday, March 28, 2013

Page 699 of 789

HFLD9
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

Set HLPR.HLPRCHAR = 1/Indicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:22:45 PM Thursday, March 28, 2013

Page 700 of 789

HFLD9
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:45 PM Thursday, March 28, 2013

Page 701 of 789

BOX HFLE3

BOX HFLE3

Page Order # :

2620

BOX INSTRUCTIONS
( HFQ4440 )

IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK (
HFQ4445 ).
ELSE GO TO BOX HFLF3 - (HFQ4450 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:45 PM Thursday, March 28, 2013

Page 702 of 789

HFLE9

HFLE9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2625

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:22:45 PM Thursday, March 28, 2013

Page 703 of 789

HFLE9
Question Text:

You mentioned that [you receive/(SP) receives] help with walking.
Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRWALK ( HFQ4445 )

TEMP

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFLF3 - (HFQ4450 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:22:46 PM Thursday, March 28, 2013

Page 704 of 789

HFLE9
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

Set HLPR.HLPRWALK = 1/Indicated.

HLPRTOIL

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:22:46 PM Thursday, March 28, 2013

Page 705 of 789

HFLE9
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:46 PM Thursday, March 28, 2013

Page 706 of 789

BOX HFLF3

BOX HFLF3

Page Order # :

2630

BOX INSTRUCTIONS
( HFQ4450 )

IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL (
HFQ4455 ).
ELSE GO TO BOX HFL4 - (HFQ4490 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:46 PM Thursday, March 28, 2013

Page 707 of 789

HFLF9

HFLF9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

2635

Display as ' Add a Person '
Display as ' Edit a Person '

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

First Name

Display ROST.ROSTFNAM.

2

Last Name

Display ROST.ROSTLNAM.

3

Relationship to SP

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:22:46 PM Thursday, March 28, 2013

Page 708 of 789

HFLF9
Question Text:

You mentioned that [you receive/(SP) receives] help with using the
toilet. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:
Cheshire Name:

PERSON_HLPRTOIL

( HFQ4455 )

TEMP

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

String

TPersPick30
1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

30

Route
BOX HFL4 - (HFQ4490 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:22:47 PM Thursday, March 28, 2013

Page 709 of 789

HFLF9
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL

Set HLPR.HLPRTOIL = 1/Indicated.

HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:22:47 PM Thursday, March 28, 2013

Page 710 of 789

HFLF9
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:47 PM Thursday, March 28, 2013

Page 711 of 789

BOX HFL4

BOX HFL4

Page Order # :

2640

BOX INSTRUCTIONS
( HFQ4490 )

IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9,
HFLD9, HFLE9, AND/OR HFLF9, GO TO HFL10 - PERSON_HLPRMOST (
HFQ4500 ).
ELSE GO TO BOX HFM1 - (HFQ4505 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES
The design intent is to check each roster where helpers are identified and
if more than one person is identified as a helper, we route to HFL10 to
determine who helps the most.

4:22:47 PM Thursday, March 28, 2013

Page 712 of 789

HFL10

HFL10

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRMOST

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Person Roster

Roster Type:

Single Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2644

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Display all persons selected at HFLA9, HFLB9, HFLC9, HFLD9,
HFLE9 and HFLF9 rosters.
Display in order of entry.

Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Which of these persons gives [you/(SP)] the most help with these

things?

Int. Instr II:

SELECT ONLY ONE.

INPUT FIELDS / ROUTING

4:22:47 PM Thursday, March 28, 2013

Page 713 of 789

HFL10

Field1:
Cheshire Name:

PERSON_HLPRMOST ( HFQ4500 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFM1 - (HFQ4505 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

Set flag that person selected helps SP the most. See instructions below.

HLPRMOST

Set HLPR.HLPRMOST = 1/Yes on HLPR where
HLPR.HLPRROST = ROST.ROSTNUM of person
selected and HLPR.HLPRRND = current round.

MOSTADLS

Set current round ADLS.MOSTADLS =
ROST.ROSTNUM of person selected.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:48 PM Thursday, March 28, 2013

Page 714 of 789

BOX HFM1

BOX HFM1

Page Order # :

2647

BOX INSTRUCTIONS
( HFQ4505 )

IF THIS IS ROUND 67, GO TO HFM1 - FALLANY ( HFQ4510 ).
ELSE GO TO HFN1 - MEMLOSS ( HFQ4580 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:22:48 PM Thursday, March 28, 2013

Page 715 of 789

HFM1

HFM1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FALLANY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2650

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?

Int. Instr II:
INPUT FIELDS / ROUTING

4:22:48 PM Thursday, March 28, 2013

Page 716 of 789

HFM1

Field1:

FALLANY

Cheshire Name:

( HFQ4510 )

HEST.FALLANY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM2 - FALLTIME ( HFQ4515 )

English text: YES
No

HFN1 - MEMLOSS ( HFQ4580 )

English text: NO
Attribute

Route

Don't know

HFN1 - MEMLOSS ( HFQ4580 )

Refusal

HFN1 - MEMLOSS ( HFQ4580 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:49 PM Thursday, March 28, 2013

Page 717 of 789

HFM2

HFM2

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

FALLTIME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2653

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:
Question Text:

Since (LAST HF MONTH YEAR), how many times [have you/has
(SP)] fallen down?

Int. Instr II:

ENTER "95" IF 95 OR MORE FALLS REPORTED.

INPUT FIELDS / ROUTING

4:22:50 PM Thursday, March 28, 2013

Page 718 of 789

HFM2

Field1:

FALLTIME

Cheshire Name:

( HFQ4515 )

HEST.FALLTIME

Item Text display:
Item Text:
Label:

Label Position:

NUMBER OF TIMES:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TFalltm
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFM3A - FALLHELP ( HFQ4520 )

Refusal

HFM3A - FALLHELP ( HFQ4520 )

FieldSize:

Min Value:
Max Value:
Mask:

1

95

Route
HFM3A - FALLHELP ( HFQ4520 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
HFM2 - FALLTIME = 1-25, DK, RF.

If not true, display "THE VALUE ENTERED FOR NUMBER OF

TIMES SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:51 PM Thursday, March 28, 2013

Page 719 of 789

HFM3A

HFM3A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FALLHELP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2656

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

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

Thinking about the [most recent) time that [you/(SP)] fell, did
(you/he/she) hurt (yourself/himself/herself) badly enough to get
medical help?

Int. Instr II:

INPUT FIELDS / ROUTING

4:22:52 PM Thursday, March 28, 2013

Page 720 of 789

HFM3A

Field1:

FALLHELP

Cheshire Name:

( HFQ4520 )

HEST.FALLHELP

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3B - FALCODE ( HFQ4525 )

English text: YES
No

HFM3B - FALCODE ( HFQ4525 )

English text: NO
Attribute

Route

Don't know

HFM3B - FALCODE ( HFQ4525 )

Refusal

HFM3B - FALCODE ( HFQ4525 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:22:53 PM Thursday, March 28, 2013

Page 721 of 789

HFM3B

HFM3B

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

FALCODE

Field 2:

FALOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2659

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

What kind of injury did [you/(SP)] have in that (most recent) fall?

[PROBE: Anything else?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING
4:22:54 PM Thursday, March 28, 2013

Page 722 of 789

HFM3B

4:22:55 PM Thursday, March 28, 2013

Page 723 of 789

HFM3B

Field1:

FALCODE

Cheshire Name:

( HFQ4525 )

NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.FALFRACT
2=HEST.FALSPRAN
3=HEST.FALBRUIS
4=HEST.FALCUT
5=HEST.FALCONC
6=HEST.FALDISLO
91=HEST.FALOTHER
96=HEST.FALNOINJ

Item Text display:

Display response options in the following order: 96, 1, 2, 3,
4, 5, 6, 91.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
Tfalcode
7
No
No

Number Label
1 BrokenBone

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3C - FALLIMIT ( HFQ4533 )

2

English text: BROKEN BONE/FRACTURE
SprainStrain

HFM3C - FALLIMIT ( HFQ4533 )

3

English text: SPRAIN/STRAIN
Bruise

HFM3C - FALLIMIT ( HFQ4533 )

4

English text: BRUISE
CutWound

HFM3C - FALLIMIT ( HFQ4533 )

5

English text: CUT/WOUND/LACERATION
Concussion

HFM3C - FALLIMIT ( HFQ4533 )

6

English text: CONCUSSION
Dislocation

HFM3C - FALLIMIT ( HFQ4533 )

91

English text: DISLOCATION
Other

HFM3B - FALOTHOS ( HFQ4530 )

96

English text: OTHER
NoInjury

HFM3C - FALLIMIT ( HFQ4533 )

English text: NO INJURY
Attribute

Route

Don't know

HFM3C - FALLIMIT ( HFQ4533 )

4:22:58 PM Thursday, March 28, 2013

Page 724 of 789

HFM3B

Don't know
Refusal

HFM3C - FALLIMIT ( HFQ4533 )

Field2:
Cheshire Name:

FALOTHOS

( HFQ4530 )

HEST.FALOTHOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
HFM3C - FALLIMIT ( HFQ4533 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1:

If HFM3B - FALCODE includes 96/NoInjury, then HFM3B ­
FALCODE should not include any other response.

If not true, display message: "INVALID RESPONSE. PLEASE

INDICATE EITHER THE TYPES OF INJURY OR INDICATE NO

INJURY."

TECHNICAL NOTES

DESIGN NOTES

4:22:59 PM Thursday, March 28, 2013

Page 725 of 789

HFM3C

HFM3C

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FALLIMIT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2662

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Did [your/(SP's)] (most recent) fall cause (you/him/her) to limit

(your/his/her) regular acivities?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:00 PM Thursday, March 28, 2013

Page 726 of 789

HFM3C

Field1:

FALLIMIT

Cheshire Name:

( HFQ4533 )

HEST.FALLIMIT

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3D - FALLBACK ( HFQ4535 )

English text: YES
No

HFM3E - FALLFEAR ( HFQ4540 )

English text: NO
Attribute

Route

Don't know

HFM3E - FALLFEAR ( HFQ4540 )

Refusal

HFM3E - FALLFEAR ( HFQ4540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:01 PM Thursday, March 28, 2013

Page 727 of 789

HFM3D

HFM3D

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

FALLBACK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2665

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

How long did it take [you/(SP)] to get back to regular activities after

(your/his/her) (most recent) fall?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:01 PM Thursday, March 28, 2013

Page 728 of 789

HFM3D

Field1:

FALLBACK

Cheshire Name:

( HFQ4535 )

HEST.FALLBACK

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

Tfalback
1
No
No

Number Label
1 LessThanOneWeek

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3E - FALLFEAR ( HFQ4540 )

2

English text: LESS THAN ONE WEEK
OneWeekOrMore

HFM3E - FALLFEAR ( HFQ4540 )

3

English text: ONE WEEK OR MORE
NeverResumed

HFM3E - FALLFEAR ( HFQ4540 )

English text: NEVER RESUMED REGULAR ACTIVITIES
Attribute
Don't know

Route
HFM3E - FALLFEAR ( HFQ4540 )

Refusal

HFM3E - FALLFEAR ( HFQ4540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:03 PM Thursday, March 28, 2013

Page 729 of 789

HFM3E

HFM3E

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

FALLFEAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2668

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6,
where 1 is "Not at all afraid of falling" and 6 is "Extremely afraid of
falling"?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:03 PM Thursday, March 28, 2013

Page 730 of 789

HFM3E

Field1:

FALLFEAR

Cheshire Name:

( HFQ4540 )

HEST.FALLFEAR

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

NUMBER:
Left

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

Integer
Tfallfear
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFN1 - MEMLOSS ( HFQ4580 )

Refusal

HFN1 - MEMLOSS ( HFQ4580 )

FieldSize:
Min Value:
Max Value:
Mask:

1
1
6

Route
HFN1 - MEMLOSS ( HFQ4580 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
The visual scale located in the question text is designed to provide the
interviewer with a conceptual example of the scale used in the question.
The end points (values 1 and 6) should be labeled with text above the
number and the numbers should be displayed on one line of text with the
digits appearing equidistant.

4:23:04 PM Thursday, March 28, 2013

Page 731 of 789

HFN1

HFN1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MEMLOSS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2674

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] experience memory loss such that it interferes
with daily activities?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:05 PM Thursday, March 28, 2013

Page 732 of 789

HFN1

Field1:

MEMLOSS

Cheshire Name:

( HFQ4580 )

HEST.MEMLOSS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN2 - PROBDECS ( HFQ4590 )

English text: YES
No

HFN2 - PROBDECS ( HFQ4590 )

English text: NO
Attribute

Route

Don't know

HFN2 - PROBDECS ( HFQ4590 )

Refusal

HFN2 - PROBDECS ( HFQ4590 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:06 PM Thursday, March 28, 2013

Page 733 of 789

HFN2

HFN2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PROBDECS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2678

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] have problems making decisions to the point
that it interferes with daily activities?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:06 PM Thursday, March 28, 2013

Page 734 of 789

HFN2

Field1:

PROBDECS

Cheshire Name:

( HFQ4590 )

HEST.PROBDECS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN3 - TROBCONC ( HFQ4600 )

English text: YES
No

HFN3 - TROBCONC ( HFQ4600 )

English text: NO
Attribute

Route

Don't know

HFN3 - TROBCONC ( HFQ4600 )

Refusal

HFN3 - TROBCONC ( HFQ4600 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:08 PM Thursday, March 28, 2013

Page 735 of 789

HFN3

HFN3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

TROBCONC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2680

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] have trouble concentrating or keeping
(your/his/her) mind on what (you are/he is/she is) doing?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:08 PM Thursday, March 28, 2013

Page 736 of 789

HFN3

Field1:

TROBCONC

Cheshire Name:

( HFQ4600 )

HEST.TROBCONC

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN4 - TIMESAD ( HFQ4610 )

English text: YES
No

HFN4 - TIMESAD ( HFQ4610 )

English text: NO
Attribute

Route

Don't know

HFN4 - TIMESAD ( HFQ4610 )

Refusal

HFN4 - TIMESAD ( HFQ4610 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:09 PM Thursday, March 28, 2013

Page 737 of 789

HFN4

HFN4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

TIMESAD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2690

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

SHOW CARD HF4

Question Text:

In the past 12 months, how much of the time did [you/(SP)] feel sad,
blue, or depressed? Would you say [you were/(SP) was] sad or
depressed all of the time, most of the time, some of the time, a little
of the time, or none of the time?

Int. Instr II:

INPUT FIELDS / ROUTING

4:23:10 PM Thursday, March 28, 2013

Page 738 of 789

HFN4

Field1:

TIMESAD

Cheshire Name:

( HFQ4610 )

HEST.TIMESAD

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TTimesad
1
No
No

Number Label
1 AllOfTheTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN5 - LOSTINTR ( HFQ4620 )

2

English text: ALL OF THE TIME
MostOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

3

English text: MOST OF THE TIME
SomeOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

4

English text: SOME OF THE TIME
ALittleOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

5

English text: A LITTLE OF THE TIME
NoneOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

English text: NONE OF THE TIME
Attribute

Route

Don't know

HFN5 - LOSTINTR ( HFQ4620 )

Refusal

HFN5 - LOSTINTR ( HFQ4620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:23:12 PM Thursday, March 28, 2013

Page 739 of 789

HFN4
DESIGN NOTES

4:23:12 PM Thursday, March 28, 2013

Page 740 of 789

HFN5

HFN5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

LOSTINTR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2700

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

In the past 12 months, [have you/has (SP)] had 2 weeks or more
when (you/he/she) lost interest or pleasure in things that
(you/he/she) usually cared about or enjoyed?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:12 PM Thursday, March 28, 2013

Page 741 of 789

HFN5

Field1:

LOSTINTR

Cheshire Name:

( HFQ4620 )

HEST.LOSTINTR

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFQ1 - LOSTURIN ( HFQ4630 )

English text: YES
No

HFQ1 - LOSTURIN ( HFQ4630 )

English text: NO
Attribute

Route

Don't know

HFQ1 - LOSTURIN ( HFQ4630 )

Refusal

HFQ1 - LOSTURIN ( HFQ4630 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:14 PM Thursday, March 28, 2013

Page 742 of 789

HFQ1

HFQ1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LOSTURIN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2703

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:

HF REFERENCE DATE: (LAST HF MONTH YEAR)

Int. Instr I:

SHOW CARD HF2

Question Text:

I'd like to ask about a health problem that is more common than
people think. Please look at this card and tell me how often, if at all,
since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine
because (you/he/she) could not control (your/his/her) bladder.

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:15 PM Thursday, March 28, 2013

Page 743 of 789

HFQ1

Field1:

LOSTURIN

Cheshire Name:

( HFQ4630 )

HEST.LOSTURIN

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TLosturin
1
No
No

Number Label
1 MoreThanOnceWeek

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFQ2 - TALKURIN ( HFQ4636 )

2

English text: MORE THAN ONCE A WEEK
AboutOnceWeek

HFQ2 - TALKURIN ( HFQ4636 )

3

English text: ABOUT ONCE A WEEK
TwoToThreeTimesMonth

HFQ2 - TALKURIN ( HFQ4636 )

4

English text: 2-3 TIMES A MONTH
AboutOnceMonth

HFQ2 - TALKURIN ( HFQ4636 )

5

English text: ABOUT ONCE A MONTH
EveryTwoToThreeMonths

HFQ2 - TALKURIN ( HFQ4636 )

6

English text: EVERY 2-3 MONTHS
OnceOrTwiceYear

HFQ2 - TALKURIN ( HFQ4636 )

7

English text: ONCE OR TWICE A YEAR
NotAtAll

BOX HFT0 - (HFQ4657 )

8

English text: NOT AT ALL
DialysisOrBladderBag

BOX HFT0 - (HFQ4657 )

English text: SP IS ON DIALYSIS OR CATHETERIZATION OR UROSTOMY OR BLADDER
BAG
Attribute
Don't know

Route
BOX HFT0 - (HFQ4657 )

Refusal

BOX HFT0 - (HFQ4657 )

BACKGROUND VARIABLE ASSIGNMENTS

4:23:17 PM Thursday, March 28, 2013

Page 744 of 789

HFQ1
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:17 PM Thursday, March 28, 2013

Page 745 of 789

HFQ2

HFQ2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

TALKURIN

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

2709

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] talked about this problem with [your/(SP’s)]
doctor or other medical professional?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:17 PM Thursday, March 28, 2013

Page 746 of 789

HFQ2

Field1:

TALKURIN

Cheshire Name:

( HFQ4636 )

HEST.TALKURIN

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
HFQ3 - FEELURIN ( HFQ4639 )

English text: YES
No

BOX HFT0 - (HFQ4657 )

English text: NO
Attribute

Route

Don't know

BOX HFT0 - (HFQ4657 )

Refusal

BOX HFT0 - (HFQ4657 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:18 PM Thursday, March 28, 2013

Page 747 of 789

HFQ3

HFQ3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FEELURIN

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

2712

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "feel".
Else display "feels".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Has [your/(SP’s)] doctor or other medical professional asked

(you/him/her) about how (you/he/she) (feel/feels) about this problem?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:19 PM Thursday, March 28, 2013

Page 748 of 789

HFQ3

Field1:

( HFQ4639 )

FEELURIN

Cheshire Name:

HEST.FEELURIN

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
HFQ4 - REASURIN ( HFQ4642 )

English text: YES
No

HFQ4 - REASURIN ( HFQ4642 )

English text: NO
Attribute

Route

Don't know

HFQ4 - REASURIN ( HFQ4642 )

Refusal

HFQ4 - REASURIN ( HFQ4642 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

4:23:20 PM Thursday, March 28, 2013

Page 749 of 789

HFQ3
DESIGN NOTES

4:23:20 PM Thursday, March 28, 2013

Page 750 of 789

HFQ4

HFQ4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

REASURIN

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

2715

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is respondent, display "lose".
Else display "loses".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Has [your/(SP’s)] doctor or other medical professional examined

(you/him/her) to figure out why (you/he/she) (lose/loses) urine?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:21 PM Thursday, March 28, 2013

Page 751 of 789

HFQ4

Field1:

( HFQ4642 )

REASURIN

Cheshire Name:

HEST.REASURIN

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
HFQ5 - SURGURIN ( HFQ4647 )

English text: YES
No

HFQ5 - SURGURIN ( HFQ4647 )

English text: NO
Attribute

Route

Don't know

HFQ5 - SURGURIN ( HFQ4647 )

Refusal

HFQ5 - SURGURIN ( HFQ4647 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

4:23:23 PM Thursday, March 28, 2013

Page 752 of 789

HFQ4
DESIGN NOTES

4:23:23 PM Thursday, March 28, 2013

Page 753 of 789

HFQ5

HFQ5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SURGURIN

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

2718

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Has [your/(SP’s)] doctor or other medical professional talked with
(you/him/her) about taking medicine or having surgery for this
problem?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:23 PM Thursday, March 28, 2013

Page 754 of 789

HFQ5

Field1:

SURGURIN

Cheshire Name:

( HFQ4647 )

HEST.SURGURIN

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 HFT0 - (HFQ4657 )

English text: YES
No

BOX HFT0 - (HFQ4657 )

English text: NO
Attribute

Route

Don't know

BOX HFT0 - (HFQ4657 )

Refusal

BOX HFT0 - (HFQ4657 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:24 PM Thursday, March 28, 2013

Page 755 of 789

BOX HFT0

BOX HFT0

Page Order # :

2721

BOX INSTRUCTIONS
( HFQ4657 )

IF THIS IS ROUND 67, GO TO BOX HFT1 - (HFQ4660 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:23:24 PM Thursday, March 28, 2013

Page 756 of 789

BOX HFT1

BOX HFT1

Page Order # :

2727

BOX INSTRUCTIONS
( HFQ4660 )

IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD ( HFQ4663 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:23:24 PM Thursday, March 28, 2013

Page 757 of 789

HFT1

HFT1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HYPETOLD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2730

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

We have recorded that [you were/(SP) was] told by a doctor that
(you had/he had/she had) hypertension, also called high blood
pressure.
[Were you/Was (SP)] told on two or more different medical visits that
(you/he/she) had high blood pressure or hypertension?
[EXPLAIN IF NECESSARY: We are interested in knowing whether
[your/(SP’s)] blood pressure was high for more than one reading.]

Int. Instr II:
4:23:25 PM Thursday, March 28, 2013

Page 758 of 789

HFT1
INPUT FIELDS / ROUTING
HYPETOLD

Field1:
Cheshire Name:

( HFQ4663 )

HEST.HYPETOLD

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

THypetol
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT2 - HYPEAGE ( HFQ4665 )

2

English text: YES
No

HFT2 - HYPEAGE ( HFQ4665 )

3

English text: NO
NeverToldPriorEntryInError

BOX HFEND - (HFQ9000 )

English text: SP NEVER HAD HIGH BLOOD PRESSURE/PREVIOUS RESPONSE ENTERED IN
ERROR
Attribute

Route

Don't know

HFT2 - HYPEAGE ( HFQ4665 )

Refusal

HFT2 - HYPEAGE ( HFQ4665 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:26 PM Thursday, March 28, 2013

Page 759 of 789

HFT2

HFT2

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HYPEAGE

Field 2:

HYPEAGE_LESSONE

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2735

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

How old [were you/was (SP)] when (you were/he was/she was) first

told that (you/he/she) had high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:28 PM Thursday, March 28, 2013

Page 760 of 789

HFT2

Field1:

HYPEAGE

Cheshire Name:

( HFQ4665 )

HEST.HYPEAGE

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

AGE:
Left

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

Integer
THypeage
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFT2 - HYPEAGE_LESSONE ( HFQ4672 )

Attribute

Route

Don't know

HFT2 - HYPEAGE_LESSONE ( HFQ4672 )

Refusal

HFT2 - HYPEAGE_LESSONE ( HFQ4672 )

4:23:30 PM Thursday, March 28, 2013

1

996

Page 761 of 789

HFT2

Field2:

HYPEAGE_LESSONE

( HFQ4672 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.HYPEAGE_LESSONE = 1/LessThanOneYear, set

HEST.HYPEAGE = 996.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

THypeage996
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT6D - HYPEHOME ( HFQ4675 )

English text: LESS THAN ONE YEAR OLD
Attribute
Empty

Route
HFT6D - HYPEHOME ( HFQ4675 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

If HYPEAGE ^= EMPTY then HYPEAGE = 1-100, DK, RF.

If not true, display message "AGE MUST BE BETWEEN 1 AND 100

OR LESS THAN ONE YEAR OLD. PLEASE REENTER."

Edit #2

HYPEAGE and HYPEAGE_LESSONE cannot both be EMPTY.

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

AGE OR SELECT "LESS THAN ONE YEAR OLD"."

Edit #3

HYPEAGE and HYPEAGE_LESSONE cannot both be FILLED.

4:23:31 PM Thursday, March 28, 2013

Page 762 of 789

HFT2
If not true, display message "INVALID ENTRY. PLEASE ENTER
AGE OR SELECT "LESS THAN ONE YEAR OLD"."
TECHNICAL NOTES

DESIGN NOTES

4:23:31 PM Thursday, March 28, 2013

Page 763 of 789

HFT6D

HFT6D

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPEHOME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2740

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Because of (your/his/her) high blood pressure, [are you/is (SP)] now
measuring (your/his/her) blood pressure at home?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:32 PM Thursday, March 28, 2013

Page 764 of 789

HFT6D

Field1:

HYPEHOME

Cheshire Name:

( HFQ4675 )

HEST.HYPEHOME

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT6G - HYPEMEDS ( HFQ4685 )

English text: YES
No

HFT6G - HYPEMEDS ( HFQ4685 )

English text: NO
Attribute

Route

Don't know

HFT6G - HYPEMEDS ( HFQ4685 )

Refusal

HFT6G - HYPEMEDS ( HFQ4685 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:33 PM Thursday, March 28, 2013

Page 765 of 789

HFT6G

HFT6G

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPEMEDS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2750

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

Because of (your/his/her) high blood pressure, [are you/is (SP)] now
taking prescribed medicine for (your/his/her) high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:34 PM Thursday, March 28, 2013

Page 766 of 789

HFT6G

Field1:

HYPEMEDS

Cheshire Name:

( HFQ4685 )

HEST.HYPEMEDS

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT6J - HYPEDRNK ( HFQ4695 )

English text: YES
No

HFT6J - HYPEDRNK ( HFQ4695 )

English text: NO
Attribute

Route

Don't know

HFT6J - HYPEDRNK ( HFQ4695 )

Refusal

HFT6J - HYPEDRNK ( HFQ4695 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:35 PM Thursday, March 28, 2013

Page 767 of 789

HFT6J

HFT6J

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPEDRNK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2760

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFG7 - DRINKDAY = 0, display "You mentioned…".
Else dispay "[Have you/Has (SP)] cut down".

Multi Field display:

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

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

(You mentioned that in a typical month in the past year [you/(SP)] did
not drink alcohol. Is that because of (your/his/her) high blood
pressure?/[Have you/Has (SP)] cut down on drinking alcoholic
beverages because of (your/his/her) high blood pressure?)

Int. Instr II:

INPUT FIELDS / ROUTING

4:23:36 PM Thursday, March 28, 2013

Page 768 of 789

HFT6J

Field1:

HYPEDRNK

Cheshire Name:

( HFQ4695 )

HEST.HYPEDRNK

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT2 - (HFQ4705 )

English text: YES
No

BOX HFT2 - (HFQ4705 )

English text: NO
Attribute

Route

Don't know

BOX HFT2 - (HFQ4705 )

Refusal

BOX HFT2 - (HFQ4705 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:37 PM Thursday, March 28, 2013

Page 769 of 789

BOX HFT2

BOX HFT2

Page Order # :

2770

BOX INSTRUCTIONS
( HFQ4705 )

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG ( HFQ4715 ).
ELSE GO TO HFT12A - HYPECTRL ( HFQ4749 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:23:37 PM Thursday, March 28, 2013

Page 770 of 789

HFT7

HFT7

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HYPELONG

Field 2:

HYPELONG_LESSON

E

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

2780

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

Int. Instr I:

Question Text:

How long [have you/has (SP)] been treated with prescribed

medicines for (your/his/her) high blood pressure?

Int. Instr II:

INPUT FIELDS / ROUTING

4:23:38 PM Thursday, March 28, 2013

Page 771 of 789

HFT7

Field1:

HYPELONG

Cheshire Name:

( HFQ4715 )

HEST.HYPELONG

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

NUMBER OF YEARS:
Left

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

Integer
THypeyrs
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFT7 - HYPELONG_LESSONE ( HFQ4722 )

Attribute

Route

Don't know

HFT7 - HYPELONG_LESSONE ( HFQ4722 )

Refusal

HFT7 - HYPELONG_LESSONE ( HFQ4722 )

4:23:40 PM Thursday, March 28, 2013

1

996

Page 772 of 789

HFT7

Field2:

HYPELONG_LESSON
E

( HFQ4722 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.HYPELONG_LESSONE = 1/LessThanOneYear, set

HEST.HYPELONG = 996.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

THypelong996
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT3 - (HFQ4725 )

English text: LESS THAN ONE YEAR
Attribute
Empty

Route
BOX HFT3 - (HFQ4725 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

If HYPELONG ^= EMPTY, then HYPELONG = 1-100, DK, RF.

If not true, display message "NUMBER OF YEARS MUST BE

BETWEEN 1 AND 100 OR LESS THAN ONE YEAR. PLEASE

REENTER."

Edit #2

HYPELONG and HYPELONG_LESSONE cannot both be EMPTY.

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

NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."

Edit #3

4:23:41 PM Thursday, March 28, 2013

Page 773 of 789

HFT7
HYPELONG and HYPELONG_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES

DESIGN NOTES

4:23:41 PM Thursday, March 28, 2013

Page 774 of 789

BOX HFT3

BOX HFT3

Page Order # :

2785

BOX INSTRUCTIONS
( HFQ4725 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFT8 - HYPEMANY (
HFQ4735 ).
ELSE GO TO HFT11A - HYPECOND ( HFQ4745 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:23:41 PM Thursday, March 28, 2013

Page 775 of 789

HFT8

HFT8

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HYPEMANY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2790

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

How many different prescribed medicines [do you/does (SP)] take for
(your/his/her) high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:42 PM Thursday, March 28, 2013

Page 776 of 789

HFT8

Field1:

HYPEMANY

Cheshire Name:

( HFQ4735 )

HEST.HYPEMANY

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

NUMBER OF PRESCRIBED MEDICINES:
Left

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

Integer
THyperx
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

HFT11A - HYPECOND ( HFQ4745 )

Refusal

HFT11A - HYPECOND ( HFQ4745 )

FieldSize:
Min Value:
Max Value:
Mask:

1
30

Route
HFT11A - HYPECOND ( HFQ4745 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

HYPEMANY = 1 - 10, DK, RF.

If not true, display message "UNLIKELY RESPONSE. PLEASE

VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:43 PM Thursday, March 28, 2013

Page 777 of 789

HFT11A

HFT11A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HYPECOND

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2800

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFT8 - HYPEMANY = 1, DK, or RF) or (HFT8 was not asked),
display "medicine".
Else display "medicines".

Multi Field display:

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

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

How often [do you/does (SP)] have trouble with side effects from
(your/his/her) blood pressure (medicine/medicines)? Please tell me if
(you/he/she) always, sometimes, or never (have/has) trouble with
side effects.
[EXPLAIN IF NECESSARY: By "side effects", I mean that the
medicine causes any condition such as fatigue, headache, or
coughing.]

4:23:44 PM Thursday, March 28, 2013

Page 778 of 789

HFT11A
Int. Instr II:

INPUT FIELDS / ROUTING

HYPECOND

Field1:
Cheshire Name:

( HFQ4745 )

HEST.HYPECOND

Item Text display:
Item Text:
Label:

Label Position:

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

Enumerated
Talways
1
No
No

Number Label
1 Always

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT12A - HYPECTRL ( HFQ4749 )

2

English text: ALWAYS
Sometimes

HFT12A - HYPECTRL ( HFQ4749 )

3

English text: SOMETIMES
Never

HFT12A - HYPECTRL ( HFQ4749 )

English text: NEVER
Attribute

Route

Don't know

HFT12A - HYPECTRL ( HFQ4749 )

Refusal

HFT12A - HYPECTRL ( HFQ4749 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:23:45 PM Thursday, March 28, 2013

Page 779 of 789

HFT11A

4:23:45 PM Thursday, March 28, 2013

Page 780 of 789

HFT12A

HFT12A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HYPECTRL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2805

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

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

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

Doctors often recommend changing your habits or lifestyle, such as
changing your diet, or getting regular exercise in order to control
blood pressure. How confident are you that [you/(SP)] can follow
these recommendation?
Would you say that you are very confident, confident, somewhat
confident, or not at all confident?

Int. Instr II:

4:23:46 PM Thursday, March 28, 2013

Page 781 of 789

HFT12A
INPUT FIELDS / ROUTING
HYPECTRL

Field1:
Cheshire Name:

( HFQ4749 )

HEST.HYPECTRL

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TConfdnt
1
No
No

Number Label
1 VeryConfident

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT4 - (HFQ4755 )

2

English text: VERY CONFIDENT
Confident

BOX HFT4 - (HFQ4755 )

3

English text: CONFIDENT
SomewhatConfident

BOX HFT4 - (HFQ4755 )

4

English text: SOMEWHAT CONFIDENT
NotAtAllConfident

BOX HFT4 - (HFQ4755 )

English text: NOT AT ALL CONFIDENT
Attribute

Route

Don't know

BOX HFT4 - (HFQ4755 )

Refusal

BOX HFT4 - (HFQ4755 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:23:47 PM Thursday, March 28, 2013

Page 782 of 789

HFT12A

4:23:47 PM Thursday, March 28, 2013

Page 783 of 789

BOX HFT4

BOX HFT4

Page Order # :

2810

BOX INSTRUCTIONS
( HFQ4755 )

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY ( HFQ4765 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:23:47 PM Thursday, March 28, 2013

Page 784 of 789

HFT13

HFT13

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPEPAY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2820

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFT8 - HYPEMANY = 1, DK, or RF) or (HFT8 was not asked),
display "medicine".
Else display "medicines".

Multi Field display:

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

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

[Do you/Does (SP)] have difficulty paying for the
(medicine/medicines) (your/his/her) doctor prescribes for
(your/his/her) high blood pressure?

Int. Instr II:

INPUT FIELDS / ROUTING

4:23:48 PM Thursday, March 28, 2013

Page 785 of 789

HFT13

Field1:

HYPEPAY

Cheshire Name:

( HFQ4765 )

HEST.HYPEPAY

Item Text display:

Item Text:

Label:

Label Position:

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

Enumerated

TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT14 - HYPESKIP ( HFQ4775 )

English text: YES
No

HFT14 - HYPESKIP ( HFQ4775 )

English text: NO
Attribute

Route

Don't know

HFT14 - HYPESKIP ( HFQ4775 )

Refusal

HFT14 - HYPESKIP ( HFQ4775 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:49 PM Thursday, March 28, 2013

Page 786 of 789

HFT14

HFT14

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPESKIP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2830

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:
Question Text:

[Do you/Does (SP)] ever skip taking (your/his/her) medicine, take
less medicine than prescribed, or share medicine because of the
cost of the medicine?

Int. Instr II:
INPUT FIELDS / ROUTING

4:23:50 PM Thursday, March 28, 2013

Page 787 of 789

HFT14

Field1:

HYPESKIP

Cheshire Name:

( HFQ4775 )

HEST.HYPESKIP

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

Enumerated
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFEND - (HFQ9000 )

English text: YES
No

BOX HFEND - (HFQ9000 )

English text: NO
Attribute

Route

Don't know

BOX HFEND - (HFQ9000 )

Refusal

BOX HFEND - (HFQ9000 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:23:51 PM Thursday, March 28, 2013

Page 788 of 789

BOX HFEND

BOX HFEND

Page Order # :

3000

BOX INSTRUCTIONS
( HFQ9000 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:23:51 PM Thursday, March 28, 2013

Page 789 of 789