Cms-p-0015a Mcbs

Medicare Current Beneficiary Survey

Section Specifications for IRF

Round 69

INTERVIEWER REMARKS QUESTIONNAIRE (FACILITY)

Created on 5/9/2014 6:13:08 PM

BOX IRQBEG

Box Instructions

GO TO IRQ1A - MORETRN.

IRQ1A Yes/No

Question Text

WHILE AT (FACILITY), DID YOU ENCOUNTER ANY PROBLEMS FOR WHICH YOU WOULD LIKE MORE TRAINING?

Field 1: MORETRN

Field 1 Routing

Value	Label	Route
0	NO	IRQ3 - FUTUREF
1	YES	IRQ2 - PROBCOM

IRQ2 Code 1

Question Text

PLEASE DESCRIBE THE PROBLEM(S).

INCLUDE AS MUCH DETAIL ABOUT THE PROBLEM(S) AS YOU RECALL.

PRESS F9 TO RECORD YOUR COMMENTS.

PRESS "1" TO CONTINUE.

Field 1: PROBCOM

Field 1 Routing

Value	Label	Route
1	CONTINUE	IRQ3 - FUTUREF

IRQ3 Yes/No

Question Text

ARE THERE ANY OTHER COMMENTS YOU WOULD LIKE TO MAKE ABOUT THE RESPONDENT(S) OR INTERVIEWING SITUATION THAT COULD HELP THE NEXT INTERVIEWER COMPLETE THIS CASE?

Field 1: FUTUREF

Field 1 Routing

Value	Label	Route
0	NO	IRQ14 - ANYFIX
1	YES	IRQ3OV - FUTURVB

IRQ3OV Verbatim Text

Question Text

PLEASE RECORD THOSE NOTES HERE.

INCLUDE AS MUCH DETAIL ABOUT THE CIRCUMSTANCES AS YOU RECALL.

THESE ENTRIES WILL APPEAR ON THE SP INFORMATION SHEET NEXT ROUND.

Field 1: FUTURVB

Field 1 Routing

Value	Label	Route
1	[Continuous answer.]	IRQ14 - ANYFIX

IRQ14 Yes/No

Question Text

IS THERE ANYTHING YOU HAVE RECORDED IN THE INSTRUMENT THAT YOU WOULD LIKE THE HOME OFFICE STAFF TO FIX?

Field 1: ANYFIX

Field 1 Routing

Value	Label	Route
0	NO	BOX IRQ1
1	YES	IRQ14A - FIXCOMM

IRQ14A Code 1

Question Text

PLEASE DESCRIBE WHAT YOU WOULD LIKE TO HAVE FIXED.

INCLUDE AS MUCH DETAIL AS POSSIBLE.

PRESS F9 TO RECORD YOUR COMMENTS.

PRESS "1" TO CONTINUE.

Field 1: FIXCOMM

Field 1 Routing

Value	Label	Route
1	CONTINUE	BOX IRQ1

BOX IRQ1

Box Instructions

IF THERE ARE NO PREVIOUS ROUND DRIVING DIRECTIONS AVAILABLE, GO TO IRQ14B - DRIVE.

ELSE GO TO IRQ14C - DRIVCHNG.

IRQ14B Yes/No

Question Text

ARE THERE DRIVING DIRECTIONS YOU CAN ENTER FOR THE NEXT INTERVIEW?

Field 1: DRIVE

Field 1 Routing

Value	Label	Route
0	NO	IRQEND - IRQENDCT
1	YES	IRQ14D - DRIVETXT

IRQ14C Yes/No

Question Text

DO YOU NEED TO UPDATE OR CHANGE THE FOLLOWING DRIVING DIRECTIONS RECORDED IN THE LAST ROUND?

PLEASE REMEMBER WHEN UPDATING OR CHANGING DRIVING DIRECTIONS, THE NEW TEXT WILL REPLACE THE PREVIOUS TEXT.

Field 1: DRIVCHNG

Field 1 Routing

Value	Label	Route
1	YES, REPLACE	IRQ14D - DRIVETXT
2	NO, KEEP THE SAME	IRQEND - IRQENDCT
3	REMOVE DRIVING DIRECTIONS	IRQEND - IRQENDCT

Other Programming Instructions

Report Display

Display report below question text.
Display previous round driving directions, PreloadFQ.DRIVETXT.

Background Variable Assignments

Variable Name	Assignment Instructions
DRIVETXT	If IRQ14C - DRIVCHNG = 2/NoKeepSame, then IRQS.DRIVETXT = PreloadFQ.DRIVETXT

IRQ14D Verbatim Text

Question Text

ENTER THE DRIVING DIRECTIONS.

(REFER TO LABEL ON CASE FOLDER.)

Field 1: DRIVETXT

Field 1 Routing

Value	Label	Route
1	[Continuous answer.]	IRQEND - IRQENDCT

IRQEND Code 1

Question Text

YOU HAVE COMPLETED THE IRQ FOR (SP).

PRESS "1" TO RETURN TO IMS.

Field 1: IRQENDCT

Field 1 Routing

Value	Label	Route
1	CONTINUE	BOX IRQEND

Other Programming Instructions

Background Variable Assignments

SPDISP:
If (FQDISP = 5/Complete or FQMDISP = 5/Complete) and (RHDISP = 96/Complete or RHMDISP=96/Complete) and (BQDISP = 96/Complete or 99/NotApplicable or 11/FinalConsentDenied or 12/Final Refusal or BQMDISP = 96/Complete) and (INDISP = 96/Complete or 99/NotApplicable or 11/FinalConsentDenied or 12/Final Refusal) and (HSDISP = 96/Complete or 99/NotApplicable or 11/FinalConsentDenied or 12/Final Refusal) and (USDISP = 96/Complete or 99/NotApplicable or 11/FinalConsentDenied or 12/Final Refusal) and PMDISP = 96/Complete or 99/NotApplicable and
EXDISP = 96/Complete or 99/NotApplicable and IRDISP = 96/Complete or 99/NotApplicable then:
If RH7-RHALIVE = 0/No and CROSYY = EMPTY then SPDISP = 50/CompleteDeceased.
Else if CROSYY = PreloadSP.EXITYY then SPDISP = 60/CompleteExitCrossover.
Else if CROSYY <> EMPTY then SPDISP = 12/CompleteDischargedAlive.
Else SPDISP = 40/CompleteAlive.

Variable Name	Assignment Instructions
IRDISP	IRDISP = 96/Complete

BOX IRQEND

Box Instructions

GO TO IMS