Cms-p-0015a Mcbs

Prescribed Medicine Summary (PMS)
Variable Name

PMSINTA

MR Screen Name
BOX PMS1

Question type
routing

PMSINTRA

no entry

Question text/description
IF SP REPORTED PRESCRIPTION MEDICINE PURCHASES IN THE PREVIOUS ROUND, GO TO PMSINTRA PMSINTA.
ELSE GO TO BOX PMS12.
During the last interview, we recorded the names of medicines that [you/(SP)] had obtained between
(SUMMARY REFERENCE DATE) and (REFERENCE DATE).

Code list

You may want to refer to the medicine names to help you recall any medicines that [you/(SP)] may have
obtained since that time, including any refills of these medicines.
PRESS F12 AND SHOW THE PRESCRIPTION MEDICINE SUMMARY TO THE RESPONDENT ON YOUR SCREEN
PMSUPDATE

PMSINTRB

code one

REFER TO SUMMARY PAGE FOR PRESCRIBED MEDICINES TO REVIEW PREVIOUS ROUND UTILIZATION.
CODE WITHOUT ASKING:

MEDICINE_PMSADD

PMS2

roster

MEDICINE_PMSEDIT

PMS3

roster

MEDICINE_PMSDELETE

PMS4

roster

GETNUM

PMS6A

grid

What is the name of the medicine that needs to be added?
ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
EDIT ALL MEDICINES AT THIS ROSTER.
What is the name of the medicine that needs to be edited?
What is the name of the medicine that needs to be deleted?
SELECT ALL MEDICINES FOR DELETION AT THIS ROSTER.
IF ALL MEDICINES ARE NOT LISTED, USE "PREVIOUS PAGE" AND ADD THE MEDICINE TO THE ROSTER. REFER
TO STATEMENTS OR RECEIPTS, IF AVAILABLE.
How many times between (SUMMARY REFERENCE DATE) and (REFERENCE DATE) did [you/(SP)] obtain
(READ MEDICINE NAME(S) BELOW)?

BOX PMS3

routing

PMS6A_IN

instance navigator

BOX PMS4

routing

PMS6A1

yes/no

BOX PMS6

routing

PMSATHMO

PMS6B

yes/no

PMSINTB

PMSINTB1

no entry

BOX PMS8

routing

NAVIGATOR

PMSATVA

(01) NO CHANGES APPEAR TO BE NECESSARY
(02) NEED TO ADD A MEDICINE NAME
(03) NEED TO CORRECT A MEDICINE NAME
(04) NEED TO DROP A MEDICINE
(01) continuous answer

(01) continuous answer
(01) continuous answer
(01) continuous answer
(-8) Don't Know
(-9) Refused

[COUNT A MEDICINE AS OBTAINED REGARDLESS OF WHO OBTAINED IT FOR THE RESPONDENT, WHEN IT
WAS OBTAINED, WHETHER OR NOT THE PRESCRIPTION COST ANYTHING, AND WHETHER OR NOT THE
RESPONDENT ACTUALLY TOOK THE MEDICINE.]
IF AT LEAST ONE PRESCRIPTION MEDICINE DISPLAYED AT PMS6A HAS NUMBER OF PURCHASES > 0 OR
EQUAL TO DK OR RF IN THE PREVIOUS ROUND, GO TO PMS6A_IN - NAVIGATOR.
ELSE GO TO PMSINTRB - PMSUPDATE.
(01) ITEM SELECTED IN INSTANCE NAVIGATOR
(02) CONTINUE INTERVIEW SELECTED
IF SP USED V.A. FACILITIES IN THE PREVIOUS ROUND, GO TO PMS6A1 - PMSATVA.
ELSE GO TO BOX PMS6.
Did [you/(SP)] obtain (this purchase/any of these purchases) of (MEDICINE NAME) through the Department (01) YES
of Veterans Affairs or V.A.?
(02) NO
(-8) Don't Know
(-9) Refused
IF SP COVERED BY A MEDICARE MANAGED CARE PLAN OR PRIVATE MANAGED CARE PLAN ANYTIME
DURING THE PREVIOUS ROUND, GO TO PMS6B - PMSATHMO.
ELSE GO TO PMSINTB1 - PMSINTB.
Did [you/(SP)] obtain (this purchase/any of these purchases) of (MEDICINE NAME) at [READ MANAGED CARE (01) YES
PLAN NAME(S) BELOW] or through a service or discount offered through [READ MANAGED CARE PLAN
(02) NO
NAME(S) BELOW]?
(-8) Don't Know
(-9) Refused
[PROBE: This could include obtaining the purchases at a plan pharmacy; at a pharmacy that honors
[your/(SP’s)] plan card; or through a mail order service that the managed care plan referred [you/(SP)] to.]
[ASK R TO GET BOTTLES AND/OR STATEMENTS IF YOU HAVE NOT ALREADY DONE SO.]
Now I need to ask you a few questions about the (MEDICINE NAME).
GO TO PMS8 - PMBOTTLE.

Prescribed Medicine Summary (PMS)
Variable Name
PMBOTTLE

MR Screen Name
PMS8

Question type
yes/no

Question text/description
CODE "YES" WITHOUT ASKING IF STATEMENT, RECEIPT, BOTTLE OR BAG IS PRESENT.
Do you have the medicine bottle, container, or bag available?
IF R DOES NOT HAVE BOTTLE, PROBE TO DETERMINE IF R CAN ANSWER QUESTIONS ABOUT THE FORM,
STRENGTH, AND QUANTITY OF THE MEDICINE.

PMSINTC

PMSINTRC

no entry

COMPLETE PMS9 -- PMS16 USING INFORMATION FROM STATEMENT, RECEIPT, MEDICINE BOTTLE OR
CONTAINER. IF THERE IS MORE THAN ONE FOR THE SAME MEDICINE, USE THE MOST RECENT CONTAINER.

PMFORM

PMS9

code one

IN WHAT FORM WAS THE MEDICINE?
[IF THE CONTAINER INDICATES "PADS", SELECT THE CATEGORY FOR "PATCHES'.]

PMFORMOS
STRNUNIT

PMS9
PMS10

verbatim text
code one

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

STRNUNOS
STRNNUM

PMS10
PMS10

verbatim text
numeric

STRNPER

PMS10

verbatim text

STRNUNIT96

PMS10

verbatim text

BOX PMS8A

routing

OTHER (SPECIFY)

IF PMS10 - STRNUNIT96 = 1/Compound, GO TO PMS10B - STRNUNI2.
ELSE GO TO BOX PMS9.

Code list
(01) YES
(02) NO
(03) NO BUT R CAN ANSWER QUESTIONS
(-8) Don't Know
(-9) Refused

(01) PILLS (TABLETS, CAPSULES)
(02) LIQUID (TO BE TAKEN ORALLY)
(03) DROPS (EYE/EAR/NOSE)
(04) OINTMENT, CREAM, LOTION (TOPICAL OR
INTERNAL)
(05) SUPPOSITORIES
(06) AEROSOL/SPRAY, INHALANT, SOLUTIONS,
DISKUS
(07) SHAMPOO, SOAP
(08) INJECTION
(09) IV INJECTION
(10) PATCHES
(11) GEL OR JELLY (TOPICAL OR INTERNAL)
(12) POWDER, GRANULES
(91) OTHER
(-8) Don't Know
(01) continuous answer
(01) MICROGRAMS (mcg, mc)
(02) MILLIGRAMS (mg)
(03) GRAINS (gr)
(04) MILLIEQUIVALENTS (meq)
(05) GRAMS (g, gm)
(06) PERCENT (%)
(07) INTERNATIONAL UNITS (IU)
(08) UNITS (U)
(91) OTHER
(96) COMPOUND/MORE THAN ONE MEDICINE
COMBINED
(-8) Don't Know
(01) continuous answer
(01) continuous answer
(-8) Don't Know
(01) continuous answer
(-8) Don't Know
(01) COMPOUND/MORE THAN ONE MEDICINE
COMBINED
(-7) Empty

Prescribed Medicine Summary (PMS)
Variable Name
STRNUNI2

MR Screen Name
PMS10B

Question type
code one

Question text/description
WHAT WAS THE STRENGTH OF THE 2ND MEDICINE IN THE COMPOUND?

STRNUNO2
STRNNUM2

PMS10B
PMS10B

verbatim text
numeric

OTHER (SPECIFY)

STRNPER2

PMS10B

verbatim text

BOX PMS9

routing

PMS11

numeric

BOX PMS10

routing

TABSADAY

PMS12

numeric

TABSADAY95

PMS12

code one

BOX PMS10A

routing

TABTAKE

PMS13

numeric

TABTAKE96

PMS13

code one

BOX PMS10B

routing

PMS14

code one

TABNUM

TAKEUNIT

IF THE PRESCRIPTION MEDICINE FORM IS PILLS, SUPPOSITORIES OR PATCHES IN THE PREVIOUS ROUND, GO
TO PMS11 - TABNUM.
ELSE GO TO PMS16 - AMTUNIT.
HOW MANY (PILLS/SUPPOSITORIES/PATCHES) WERE IN THE CONTAINER WHEN IT WAS OBTAINED?
(01) continuous answer
(-8) Don't Know
(-9) Refused
IF PRESCRIPTION MEDICINE FORM IS PILLS OR SUPPOSITORIES IN THE PREVIOUS ROUND AND PMS11 TABNUM=DK, GO TO PMS12 - TABSADAY.
ELSE GO TO BOX PMS11.
HOW MANY (PILLS/SUPPOSITORIES) WERE TO BE TAKEN IN A DAY?
(01) continuous answer
(-7) Empty
(-8) Don't Know
(01) LESS THAN WHOLE
(02) TAKE AS NEEDED
(-7) Empty
IF PMS12 - TABSADAY = DK, GO TO BOX PMS11.
ELSE IF PMS12 - TABSADAY95 = 2/TakeAsNeeded, GO TO PMS13 - TABTAKE.
ELSE GO TO PMS14 - TAKEUNIT.
How many (pills/suppositories) did [you/(SP)] usually take in a day?

IF PMS13 - TABTAKE96 = 1/DontTakeEveryDay, GO TO BOX PMS11.
ELSE GO TO PMS14 - TAKEUNIT.
HOW MANY DAYS OR WEEKS WAS THE MEDICINE TO BE TAKEN?
[IF THE BOTTLE SAYS TO TAKE A CERTAIN DOSE OF THE MEDICINE DAILY WITHOUT GIVING A TIME FRAME
(E.G., “TAKE 2 PILLS DAILY”), SELECT “TAKE EVERY DAY”.]

TAKENUM

PMS14

numeric

Code list
(01) MICROGRAMS (mcg, mc)
(02) MILLIGRAMS (mg)
(03) GRAINS (gr)
(04) MILLIEQUIVALENTS (meq)
(05) GRAMS (g, gm)
(06) PERCENT (%)
(07) INTERNATIONAL UNITS (IU)
(08) UNITS (U)
(91) OTHER
(96) COMPOUND/MORE THAN ONE MEDICINE
COMBINED
(-8) Don't Know
(01) continuous answer
(01) continuous answer
(-8) Don't Know
(01) continuous answer
(-8) Don't Know

(01) continuous answer
(-8) Don't Know
(-9) Refused
(01) DON'T TAKE EVERY DAY
(-7) Empty

(01) DAYS
(02) WEEKS
(03) TAKE UNTIL GONE
(04) TAKE AS NEEDED
(05) TAKE EVERY DAY
(-8) Don't Know
(-9) Refused
(01) continuous answer

Prescribed Medicine Summary (PMS)
Variable Name
AMTUNIT

MR Screen Name
PMS16

Question type
code one

AMTUNOS
AMTNUM

PMS16
PMS16

verbatim text
numeric

BOX PMS11
BOX PMS12

routing
routing

Question text/description
HOW MUCH MEDICINE WAS IN THE CONTAINER WHEN IT WAS OBTAINED?
[PLEASE ENTER THE AMOUNT IN THE CONTAINER, NOT THE STRENGTH OF THE MEDICINE.]

GO TO PMS6A_IN - NAVIGATOR.
GO TO NEXT SECTION

Code list
(01) OUNCES (oz)
(02) GRAMS (g, gm)
(03) MILLILITERS (ml, cc)
(04) MILLIEQUIVALENTS (meq)
(05) MILLIGRAMS (mg)
(06) MICROGRAMS (mcg)
(07) PUFFS, DOSES, BLISTERS
(91) OTHER
(-8) Don't Know
(01) continuous answer
(01) continuous answer
(-8) Don't Know