Section Specifications for FQM
Round 69
FACILITY QUESTIONNAIRE MISSING DATA
Created on 5/9/2014 6:10:39 PM
Box Instructions
GO TO FQMISS1 - FQMISSNG.
Question Text
THE FOLLOWING ITEMS ARE MISSING FROM FQ. CONFIRM THAT THE RESPONDENT CAN ANSWER AT LEAST ONE QUESTION.
PRESS "1" TO CONTINUE.
Field 1: FQMISSNG
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FQM1 |
Other Programming Instructions
Report Display
Report
Display instructions:
If FQ1A - PLACNAME = DK or RF and FQM1A -
MSFNAME = DK, EMPTY or NULL, then display "IS FACILITY'S NAME
CORRECT?".
If FQ2 - FADDROK = DK or RF and FQM2A - MSFADDR
= DK, EMPTY, or NULL, then display "IS FACILITY'S ADDRESS
CORRECT?".
IF FQ4 - MADDROK = RF and FQM2C - MSMADDR = DK,
EMPTY or NULL, then display "IS FACILITY'S MAILING ADDRESS
CORRECT?"
If FQ3 - FADMNOK = DK or RF and FQM3A - MSFADMN =
DK, EMPTY or NULL, then display "IS FACILITY'S ADMINISTRATOR
CORRECT?".
If FQ5 - FPHONOK = DK or RF and FQM4A - MSFPHON
= DK, EMPTY or NULL, then display "IS FACILITY'S PHONE NUMBER
CORRECT?".
If FA1 - PLACTYP1 = RF and FQM5A - MSPLACTY =
DK, EMPTY or NULL, then display "WHAT IS THE TYPE OF PLACE FOR
(FACILITY)?".
If FA12 - BEDSNUM = DK or RF and FQM6A -
MSBEDSNU = DK, EMPTY or NULL, then display "WHAT IS THE NUMBER
OF BEDS IN (FACILITY)?".
If FA13 - CAIDCRT1 = DK or RF and
FQM7A - MSCAIDC1 = DK, EMPTY or NULL, then display "IS THERE
MEDICAID CERTIFICATION FOR (FACILITY)?".
If FA14 - CARECRT1
= DK or RF and FQM8A - MSCAREC1 = DK, EMPTY or NULL, then display "IS
THERE MEDICARE CERTIFICATION FOR (FACILITY)?".
If FA15 -
CAIDICF = DK or RF and FQM9A - MSCAIDIC = DK, EMPTY or NULL, then
display "IS THERE MEDICAID-ICF/MR CERTIFICATION FOR
(FACILITY)?".
If FA16 - HDEPTLIC = DK or RF and (FA13 -
CAIDCRT1, FA14 - CARECRT1, FA15 - CAIDICF, FQM7A - MSCAIDC1, FQM8 -
MSCAREC1, and FQM9A MSCAIDIC <> 1/Yes), and FQM10A - MSHDEPTL =
DK, EMPTY or NULL, then display "IS THERE STATE DEPARTMENT
LICENSING FOR (FACILITY)?".
If FA18 - HDEPTPCH = DK or RF
and FQM11A - MSHDEPTP = DK, EMPTY or NULL, then display "IS
THERE NON-NURSING LICENSING FOR (FACILITY)?".
Report
Display:
(IS FACILITY'S NAME CORRECT?)
(IS FACILITY'S
ADDRESS CORRECT?)
(IS FACILITY'S MAILING ADDRESS CORRECT?)
(IS
FACILITY'S ADMINISTRATOR CORRECT?)
(IS FACILITY'S PHONE NUMBER
CORRECT?)
[WHAT IS THE TYPE OF PLACE FOR (FACILITY)?]
[WHAT
IS THE NUMBER OF BEDS IN (FACILITY)?]
[IS THERE MEDICAID
CERTIFICATION FOR (FACILITY)?]
[IS THERE MEDICARE CERTIFICATION
FOR (FACILITY)?]
[IS THERE MEDICAID-ICF/MR CERTIFICATION FOR
(FACILITY)?]
[IS THERE STATE DEPARTMENT LICENSING FOR
(FACILITY)?]
[IS THERE NON-NURSING LICENSING FOR (FACILITY)?]
Box Instructions
IF (FQ1A - PLACNAME = DK OR RF) AND (FQM1A - MSFNAME = DK, EMPTY, OR NULL), GO TO FQM1A - MSFNAME.
ELSE GO TO BOX FQM2.
Question Text
I
need to verify that our information about you is correct.
Is
(FACILITY) the exact name of this (facility/home)?
Field 1: MSFNAME
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQM1B - ADDRNAME |
1 |
YES |
BOX FQM2 |
|
Don't Know |
BOX FQM2 |
|
Refused |
BOX FQM2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PLACNAME |
If FQM1A - MSFNAME = 1/Yes or RF, then PLAC.PLACNAME = PreloadPLAC.PLACNAME |
PLACNAME |
If FQM1A - MSFNAME = 1/Yes or RF, then FQ.PLACNAME = PreloadPLAC.PLACNAME |
Question Text
What is the exact name of the place where (SP) was physically located on (REFERENCE DATE)?
Field 1: ADDRNAME
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PLACNAME |
PLAC.PLACNAME = FQM1B - ADDRNAME |
PLACNAME |
FQ.PLACNAME = FQM1B - ADDRNAME |
Design Notes
Use the updated FACILITY name for "(FACILITY)". Fill in all questions that follow.
Box Instructions
IF (FQ2 - FADDROK = DK OR RF) AND (FQM2A - MSFADDR = DK, EMPTY, OR NULL), GO TO FQM2A - MSFADDR.
ELSE GO TO BOX FQM2A1.
Question Text
Is [READ ADDRESS LISTED BELOW] the correct address of the place where (SP) was physically located on (REFERENCE DATE)?
Field 1: MSFADDR
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQM2B - ADDRESS |
1 |
YES |
BOX FQM2A1 |
|
Don't Know |
BOX FQM2A1 |
|
Refused |
BOX FQM2A1 |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD ADDRESS =
PreloadPLAC.ADDRESS
PRELOAD CITY = PreloadPLAC.ADDRCITY
PRELOAD
STATE = PreloadPLAC.ADDRSTAT
PRELOAD ZIP =
PreloadPLAC.ADDRZIP
Report Header:
PREVIOUSLY
REPORTED ADDRESS:
Report Display:
(PRELOAD
ADDRESS)
(PRELOAD CITY) (PRELOAD STATE) (PRELOAD ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRESS |
If FQM2A - MSFADDR = 1/Yes or RF then FQ.ADDRESS = PreloadPLAC.ADDRESS |
ADDRCITY |
If FQM2A - MSFADDR = 1/Yes or RF then FQ.ADDRCITY = PreloadPLAC.ADDRCITY |
ADDRSTAT |
If FQM2A -
MSFADDR = 1/Yes or RF then FQ.ADDRSTAT = |
ADDRZIP |
If FQM2A - MSFADDR = 1/Yes or RF then FQ.ADDRZIP = PreloadPLAC.ADDRZIP |
ADDRESS |
If FQM2A - MSFADDR = 1/Yes or RF then PLAC.ADDRESS = PreloadPLAC.ADDRESS |
ADDRCITY |
If FQM2A - MSFADDR = 1/Yes or RF then PLAC.ADDRCITY = PreloadPLAC.ADDRCITY |
ADDRSTAT |
If FQM2A -
MSFADDR = 1/Yes or RF then PLAC.ADDRSTAT = |
ADDRZIP |
If FQM2A - MSFADDR = 1/Yes or RF then PLAC.ADDRZIP = PreloadPLAC.ADDRZIP |
Question Text
What is the correct address of the place where (SP) was physically located on (REFERENCE DATE)?
Field 1: ADDRESS
ADDRESS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM2B - ADDRCITY |
Field 2: ADDRCITY
CITY
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM2B - ADDRSTAT |
Field 3: ADDRSTAT
STATE
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM2B - ADDRZIP |
Field 4: ADDRZIP
ZIP
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM2A1 |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD ADDRESS =
PreloadPLAC.ADDRESS
PRELOAD CITY = PreloadPLAC.ADDRCITY
PRELOAD
STATE = PreloadPLAC.ADDRSTAT
PRELOAD ZIP =
PreloadPLAC.ADDRZIP
Report Header:
PREVIOUSLY
REPORTED ADDRESS:
Report Display:
(PRELOAD
ADDRESS)
(PRELOAD CITY) (PRELOAD STATE) (PRELOAD ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRESS |
PLAC.ADDRESS = FQM2B - ADDRESS |
ADDRCITY |
PLAC.ADDRCITY = FQM2B - ADDRCITY |
ADDRSTAT |
PLAC.ADDRSTAT = FQM2B - ADDRSTAT |
ADDRZIP |
PLAC.ADDRZIP = FQM2B - ADDRZIP |
Design Notes
Use the updated FQM2B - ADDRSTAT state for "(PREFERRED NAME(S) FOR MEDICAID)".
Box Instructions
IF (FQ4 - MADDROK = RF) AND (FQM2C - MSMADDR = EMPTY, OR NULL), GO TO FQM2C - MSMADDR.
ELSE GO TO BOX FQM3.
Question Text
Is [READ ADDRESS LISTED BELOW] the correct address for your office?
Field 1: MSMADDR
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQM2D - MAILADDR |
1 |
YES |
BOX FQM3 |
|
Refused |
BOX FQM3 |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD MAILING ADDRESS = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILADDR.
Else display PLAC.ADDRESS.
PRELOAD MAILING CITY = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILCITY.
Else display PLAC.ADDRCITY.
PRELOAD MAILING STATE = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILSTAT.
Else display PLAC.ADDRSTAT.
PRELOAD MAILING ZIP = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILZIP.
Else display PLAC.ADDRZIP.
Report Header:
PREVIOUSLY
REPORTED MAILING ADDRESS:
Report Display:
(PRELOAD
MAILING ADDRESS)
(PRELOAD MAILING CITY) (PRELOAD MAILING STATE)
(PRELOAD MAILING ZIP)
Background Variable Assignments
Variable Name |
Assignment Instructions |
MAILADDR |
If FQ4-MADDROK =
1/Yes or RF: |
MAILCITY |
If FQ4-MADDROK =
1/Yes or RF: |
MAILSTAT |
If FQ4-MADDROK =
1/Yes or RF: |
MAILZIP |
If FQ4-MADDROK =
1/Yes or RF: |
Question Text
What is the correct address for your office?
Field 1: MAILADDR
ADDRESS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM2D - MAILCITY |
|
Don't Know |
FQM2D - MAILCITY |
|
Refused |
FQM2D - MAILCITY |
Field 2: MAILCITY
CITY
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM2D - MAILSTAT |
|
Don't Know |
FQM2D - MAILSTAT |
|
Refused |
FQM2D - MAILSTAT |
Field 3: MAILSTAT
STATE
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM2D - MAILZIP |
|
Don't Know |
FQM2D - MAILZIP |
|
Refused |
FQM2D - MAILZIP |
Field 4: MAILZIP
ZIP
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM3 |
|
Don't Know |
BOX FQM3 |
|
Refused |
BOX FQM3 |
Other Programming Instructions
Report Display
Report
Display Instructions:
PRELOAD MAILING ADDRESS = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILADDR.
Else display PLAC.ADDRESS.
PRELOAD MAILING CITY = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILCITY.
Else display PLAC.ADDRCITY.
PRELOAD MAILING STATE = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILSTAT.
Else display PLAC.ADDRSTAT.
PRELOAD MAILING ZIP = If
PreloadFQ.MAILADDR <> EMPTY, then display PreloadFQ.MAILZIP.
Else display PLAC.ADDRZIP.
Report Header:
PREVIOUSLY
REPORTED MAILING ADDRESS:
Report Display:
(PRELOAD
MAILING ADDRESS)
(PRELOAD MAILING CITY) (PRELOAD MAILING STATE)
(PRELOAD MAILING ZIP)
Box Instructions
IF (FQ3 - FADMNOK = DK OR RF) AND (FQM3A - MSFADMN = DK, EMPTY, OR NULL), GO TO FQM3A - MSFADMN.
ELSE GO TO BOX FQM4.
Question Text
[Is (ADMINISTRATOR'S NAME)/Are you] (still) the current administrator of (FACILITY)?
Field 1: MSFADMN
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQM3B - FACRNAMM |
1 |
YES |
BOX FQM4 |
|
Don't Know |
BOX FQM4 |
|
Refused |
BOX FQM4 |
Question Text
What is the current administrator's name?
SELECT A RESPONSE BELOW OR ADD TO THE PERSON ROSTER.
Field 1: FACRNAMM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM4 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
XFACRADM |
PLAC.XFACRADM = FACRNUM added/selected in PLAC where PLACNUM = 001 |
XFACRADM |
FQ.XFACRADM = FACRNUM added/selected |
Box Instructions
IF (FQ5 - FPHONOK = DK OR RF) AND (FQM4A - MSFPHON = DK, EMPTY, OR NULL), GO TO FQM4A - MSFPHON.
ELSE GO TO BOX FQM5.
Question Text
(VERIFY PHONE NUMBER IS FOR FQ RESPONDENT. DO NOT READ ALOUD.)
Is (FACILITY AREA CODE AND PHONE NUMBER) the correct phone number for (FACILITY)?
Field 1: MSFPHON
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
FQM4B - ADDRAREA |
1 |
YES |
BOX FQM5 |
|
Don't Know |
BOX FQM5 |
|
Refused |
BOX FQM5 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRAREA |
If FQM4A - MSFPHON = 1/Yes or RF then PLAC.ADDRAREA = PreloadPLAC.ADDRAREA |
ADDREXCH |
If FQM4A - MSFPHON = 1/Yes or RF then PLAC.ADDREXCH = PreloadPLAC.ADDREXCH |
ADDRLOCL |
If FQM4A - MSFPHON = 1/Yes or RF then PLAC.ADDRLOCL = PreloadPLAC.ADDRLOCL |
ADDRAREA |
If FQM4A - MSFPHON = 1/Yes or RF then FQ.ADDRAREA = PreloadPLAC.ADDRAREA |
ADDREXCH |
If FQM4A - MSFPHON = 1/Yes or RF then FQ.ADDREXCH = PreloadPLAC.ADDREXCH |
ADDRLOCL |
If FQM4A - MSFPHON = 1/Yes or RF then FQ.ADDRLOCL = PreloadPLAC.ADDRLOCL |
Question Text
What is the phone number?
Field 1: ADDRAREA
AREA CODE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM4B - ADDREXCH |
|
Don't Know |
FQM4B - ADDREXCH |
|
Refused |
FQM4B - ADDREXCH |
Field 2: ADDREXCH
EXCHANGE
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
FQM4B - ADDRLOCL |
|
Don't Know |
FQM4B - ADDRLOCL |
|
Refused |
FQM4B - ADDRLOCL |
Field 3: ADDRLOCL
LOCAL
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM5 |
|
Don't Know |
BOX FQM5 |
|
Refused |
BOX FQM5 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ADDRAREA |
If FQM4B - ADDRAREA <> DK, RF then PLAC.ADDRAREA = FQM4B - ADDRAREA. Else PLAC.ADDRAREA = PreloadPLAC.ADDRAREA. |
ADDREXCH |
If FQM4B - ADDREXCH <> DK, RF then PLAC.ADDREXCH = FQM4B - ADDREXCH. Else PLAC.ADDREXCH = PreloadPLAC.ADDREXCH. |
ADDRLOCL |
If FQM4B - ADDRLOCL <> DK, RF then PLAC.ADDRLOCL = FQM4B - ADDRLOCL. Else PLAC.ADDRLOCL = PreloadPLAC.ADDRLOCL. |
ADDRAREA |
If FQM4B - ADDRAREA <> DK, RF then FQ.ADDRAREA = FQM4B - ADDRAREA. Else FQ.ADDRAREA = PreloadPLAC.ADDRAREA. |
ADDREXCH |
If FQM4B - ADDREXCH <> DK, RF then FQ.ADDREXCH = FQM4B - ADDREXCH. Else FQ.ADDREXCH = PreloadPLAC.ADDREXCH. |
ADDRLOCL |
If FQM4B - ADDRLOCL <> DK, RF then FQ.ADDRLOCL = FQM4B - ADDRLOCL. Else FQ.ADDRLOCL = PreloadPLAC.ADDRLOCL. |
Box Instructions
IF (FA1 - PLACTYP1 = RF) AND (FQM5A - MSPLACTY = EMPTY OR NULL), GO TO FQM5A - MSPLACTY.
ELSE GO TO BOX FQM6.
Question Text
SHOW CARD FA2
What type of place is (FACILITY)?
PRESS
F1 FOR PLACE DEFINITIONS.
IF RESPONDENT REPORTS CCRC OR
RETIREMENT COMMUNITY, PROBE FOR TYPE OF PLACE FOR UNIT WHERE SP
RESIDES. DO NOT ENTER "OTHER".
Field 1: MSPLACTY
Field 1 Routing
Value |
Label |
Route |
1 |
FREE STANDING NURSING HOME |
BOX FQM6 |
4 |
NURSING HOME UNIT WITHIN A CCRC OR RETIREMENT CENTER |
BOX FQM6 |
6 |
HOSPITAL |
DO NOT DISPLAY. |
7 |
HOSPITAL-BASED SNF UNIT |
DO NOT DISPLAY |
8 |
ASSISTED LIVING FACILITY |
BOX FQM6 |
9 |
BOARD AND CARE HOME |
BOX FQM6 |
10 |
DOMICILIARY CARE HOME |
BOX FQM6 |
11 |
PERSONAL CARE HOME |
BOX FQM6 |
12 |
REST HOME/RETIREMENT HOME |
BOX FQM6 |
13 |
HOME OFFICE OR MANAGEMENT OFFICE FOR A CHAIN OR GROUP OF OFF-SITE NURSING FACILITIES |
DO NOT DISPLAY. |
15 |
MENTAL HEALTH CENTER/PSYCHIATRIC SETTING |
BOX FQM6 |
16 |
INSTITUTION FOR THE MENTALLY RETARDED/DEVELOPMENTALLY DISABLED |
BOX FQM6 |
17 |
REHABILITATION FACILITY |
BOX FQM6 |
91 |
OTHER |
FQM5A - MSPLTPOS |
|
Refused |
BOX FQM6 |
Field 2: MSPLTPOS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM6 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
PLACTYPE |
If FQM5A - MSPLACTY = 1/FreeStandingNursingHome or 4/NursingHomeUnitCCRC then PLAC.PLACTYPE = 4/NursingHomeorNHUnit. Else PLAC.PLACTYPE = FQM5A - MSPLACTY |
PLACTPOS |
If FQM5A -
MSPLACTY = 91/Other, then PLAC.PLACTPOS = FQM5A-MSPLTPOS. |
Box Instructions
IF (FA12 - BEDSNUM = DK OR RF) AND (FQM6A - MSBEDSNU = DK, EMPTY, OR NULL), GO TO FQM6A - MSBEDSNU.
ELSE GO TO BOX FQM7.
Question Text
How many beds does (FACILITY) have?
PRESS F1 FOR EXPANDED DEFINITIONS OF "BEDS".
Field 1: MSBEDSNU
NO. OF BEDS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM7 |
|
Don't Know |
BOX FQM7 |
|
Refused |
BOX FQM7 |
Box Instructions
IF (FA13 - CAIDCRT1 = DK OR RF) AND (FQM7A - MSCAIDC1 = DK, EMPTY, OR NULL), GO TO FQM7A - MSCAIDC1.
ELSE GO TO BOX FQM8.
Question Text
Is (FACILITY) certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as a Nursing Facility (NF)?
IF
R MENTIONS:
-ICF (INTERMEDIATE CARE FACILITY), NOTE IN COMMENTS
AND ENTER 1.
-ICF/MR (INTERMEDIATE CARE FACILITY- MENTAL
RETARDATION), NOTE IN COMMENTS AND ENTER 0.
Field 1: MSCAIDC1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FQM8 |
1 |
YES |
BOX FQM8 |
|
Don't Know |
BOX FQM8 |
|
Refused |
BOX FQM8 |
Box Instructions
IF (FA14 - CARECRT1 = DK OR RF) AND (FQM8A - MSCAREC1 = DK, EMPTY, OR NULL), GO TO FQM8A - MSCAREC1.
ELSE GO TO BOX FQM9.
Question Text
Is (FACILITY) certified by Medicare as a SNF?
Field 1: MSCAREC1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FQM9 |
1 |
YES |
BOX FQM9 |
|
Don't Know |
BOX FQM9 |
|
Refused |
BOX FQM9 |
Box Instructions
IF (FA15 - CAIDICF = DK OR RF) AND (FQM9A - MSCAIDIC = DK, EMPTY, OR NULL), GO TO FQM9A - MSCAIDIC.
ELSE GO TO BOX FQM10.
Question Text
Does (FACILITY) have any beds certified by [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] as ICF-MR (Intermediate Care Facility for the Mentally Retarded) beds?
Field 1: MSCAIDIC
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX FQM10 |
1 |
YES |
BOX FQM10 |
|
Don't Know |
BOX FQM10 |
|
Refused |
BOX FQM10 |
Box Instructions
IF (FA16 - HDEPTLIC = DK OR RF) AND (FQM10A - MSHDEPTL = DK, EMPTY, OR NULL) AND (FA13 - CAIDCRT1, FA14 - CARECRT1, FA15 - CAIDICF, FQM7A - MSCAIDC1, FQM8A - MSCAREC1 AND FQM9A - MSCAIDIC <> 1/Yes) GO TO FQM10A - MSHDEPTL.
ELSE GO TO BOX FQM11.
Question Text
Is (FACILITY) licensed as a nursing (facility/home) by the (STATE) State Health Department or by some other agency?
Field 1: MSHDEPTL
Field 1 Routing
Value |
Label |
Route |
0 |
NO, NOT LICENSED |
BOX FQM11 |
1 |
YES, LICENSED BY STATE HEALTH DEPARTMENT |
BOX FQM11 |
2 |
YES, LICENSED BY SOME OTHER AGENCY |
FQM10A - MSHDPLOS |
|
Don't Know |
BOX FQM11 |
|
Refused |
BOX FQM11 |
Field 2: MSHDPLOS
OTHER AGENCY (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQM11 |
Box Instructions
IF (FA18 - HDEPTPCH = DK OR RF) AND (FQM11A - MSHDEPTP = DK, EMPTY, OR NULL), GO TO FQM11A - MSHDEPTP.
ELSE GO TO BOX FQMCOMP.
Question Text
Does (FACILITY) have any beds licensed as personal care, board and care, assisted living, or domiciliary care beds by the (STATE) State Health Department or by some other state agency?
Field 1: MSHDEPTP
Field 1 Routing
Value |
Label |
Route |
0 |
NO, NOT LICENSED |
BOX FQMCOMP |
1 |
YES, LICENSED BY STATE HEALTH DEPARTMENT |
BOX FQMCOMP |
2 |
YES, LICENSED BY SOME OTHER AGENCY |
FQM11A - MSHDPPOS |
|
Don't Know |
BOX FQMCOMP |
|
Refused |
BOX FQMCOMP |
Field 2: MSHDPPOS
OTHER AGENCY (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX FQMCOMP |
Box Instructions
GO TO FQMEND - FQMSEND.
Question Text
YOU HAVE REACHED THE END OF THE SECTION FOR FACILITY LEVEL MISSING DATA.
PRESS "1" TO RETURN TO FACILITY NAVIGATION SCREEN.
Field 1: FQMSEND
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX FQMEND |
Other Programming Instructions
Background Variable Assignments
FQMDDISP:
If
FQM1A - MSFNAME <> DK and FQM2A - MSFADDR <> DK and FQM2C
- MSMADDR <> DK and FQM3A - MSFADMN <> DK and FQM4A -
MSFPHON <> DK and FQM6A - MSBEDSNU <> DK and FQM7A -
MSCAIDC1 <> DK and FQM8A - MSCAREC1 <> DK, and FQM9A -
MSCAIDIC <> DK and FQM10A - MSHDEPTL <> DK and FQM11A -
MSHDEPTP <> DK, then FQMDDISP = 5/Complete. Else FQMDDISP =
3/StartedNotComplete.
Box Instructions
GO TO NAVIGATOR
Other Programming Instructions
Design Notes
Any
DK responses to the following variables should be set to EMPTY upon
return to the Navigator:
FQM1A - MSFNAME
FQM2A - MSFADDR
FQM2C - MSMADDR
FQM3A - MSFADMN
FQM4A - MSFPHON
FQM6A - MSBEDSNU
FQM7A - MSCAIDC1
FQM8A - MSCAREC1
FQM9A - MSCAIDIC
FQM10A - MSHDEPTL
FQM11A -
MSHDEPTP
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ryan Hubbard |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |