Cms-p-0015a Mcbs

Prescribed Medicine Utilization (PMQ)
Variable Name
PMINTA

MR Screen Name
PMINTROA

Question type
no entry

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

Code list

[While talking about medical visits, you mentioned some medicine(s): [READ MEDICINE NAME(S) BELOW.]]
[Now I’d like to talk about prescribed medicines.]
PMFILLED

PM1PMMEDS

MEDICINE_PM1

PM1

yes/no

BOX PMA1

routing

PM1A

no entry

PM2

roster

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

(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP DO NOT
DISPLAY.DATA EDITING ONLY.
(-8) DON'T KNOW
[COUNT A MEDICINE AS "FILLED" REGARDLESS OF WHO OBTAINED IT FOR THE RESPONDENT, WHEN IT WAS (-9) REFUSED
OBTAINED, WHETHER OR NOT THE PRESCRIPTION COST ANYTHING, AND WHETHER OR NOT THE
RESPONDENT ACTUALLY TOOK THE MEDICINE.]
IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN ASKED IN THE CURRENT ROUND, GO
TO PM1A - PM1PMMEDS.
ELSE GO TO PM2 - MEDICINE_PM1.
It would be helpful if I could look at any medicine bottle(s), container(s), or bag(s) that you have so that I can
spell the medicine name correctly and enter the strength of the medicine. [Also, please take out
[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME) medicine statements, which should have that
same information on them.]
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same information for all of the medicines [you/(SP)]
obtained since the last interview, if you’d like to get those bottles, too.
What is the name of the medicine?
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
[AT TOP OF SCREEN DISPLAY LINK TO PRESCRIBED MEDICINE LOOKUP WITH LABEL "Search Medicine"]
Please tell me the names of these medicines.
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.

PMEDNAME

PM2

verbatim

PMSTRUNI
ADDP

PM2
PM2B

verbatim
roster

PMREFILL

PM3

yes/no

[DISPLAY ROSTER WITH ALL MEDICINES FROM PRIOR ROUNDS (WHERE EVENT.EVNTTYPE='PM' AND
EVNTDFLG^=1)]
DISPLAY MEDICINE NAME (EVENT.PMEDNAME) AND STRENGTH (EVENT.PRMSTRUNI)
What is the name of the medicine?
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
[PRESCRIPTION MEDICINE LOOKUP CALLED FROM THIS SCREEN]
STRENGTH:
[DISPLAY MEDICINE ROSTER]
People sometimes forget to mention refills of earlier prescriptions. (In addition to what you’ve told me
about, did/Did) [you/(SP)] have any prescriptions refilled [since (REFERENCE DATE/UTILDATE)/between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)]?
[COUNT A MEDICINE AS "REFILLED" 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.]

(01) CONTINUOUS ANSWER
[DISPLAY MEDICINE ROSTER AS RESPONSE OPTIONS:
1. [MEDICINE 1]
2. [MEDICINE 2]
…
N. [MEDICINE N]
N+1. ADD ANOTHER
[DISPLAY MEDICINE NAME AND STRENGTH FOR
EACH.
IF NO EXISTING MEDICINES DISPLAY "NO MEDICINES
LISTED"]

(01) ADD ANOTHER
(02) ALL DONE
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Prescribed Medicine Utilization (PMQ)
Variable Name

PM2PMMEDS

MEDICINE_PM2

MR Screen Name
BOX PMA2

Question type
routing

PM3A

no entry

PM4

roster

Question text/description
Code list
IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN ASKED IN THE CURRENT ROUND, GO
TO PM3A - PM2PMMEDS.
ELSE GO TO PM4 - MEDICINE_PM2.
It would be helpful if I could look at any medicine bottle(s), container(s), or bag(s) that you have so that I can
spell the medicine name correctly and enter the strength of the medicine. [Also, please take out
[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME) medicine statements, which should have that
same information on them.]
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same information for all of the medicines [you/(SP)]
obtained since the last interview, if you’d like to get those bottles, too.
[AT TOP OF SCREEN DISPLAY LINK TO PRESCRIBED MEDICINE LOOKUP WITH LABEL "Search Medicine"]
Please tell me all the names of these medicines.
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
[DISPLAY ROSTER WITH ALL MEDICINES FROM PRIOR ROUNDS (WHERE EVENT.EVNTTYPE='PM' AND
EVNTDFLG^=1)]
DISPLAY MEDICINE NAME (EVENT.PMEDNAME) AND STRENGTH (EVENT.PRMSTRUNI)

(01) CONTINUOUS ANSWER

[DISPLAY MEDICINE ROSTER AS RESPONSE OPTIONS:
1. [MEDICINE 1]
2. [MEDICINE 2]
…
N. [MEDICINE N]
N+1. ADD ANOTHER
[DISPLAY MEDICINE NAME AND STRENGTH FOR
EACH.
IF NO EXISTING MEDICINES DISPLAY "NO MEDICINES
LISTED"]

PMEDNAME

PM4

verbatim

PMSTRUNI
ADDP

PM4
PM4B

verbatim
roster

PMDRPHON

PM5

yes/no

What is the name of the medicine?
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
[PRESCRIPTION MEDICINE LOOKUP CALLED FROM THIS SCREEN]
STRENGTH:
[DISPLAY MEDICINE ROSTER]
People sometimes forget to mention prescriptions that were phoned in by a doctor. (In addition to what
you’ve told me about, did/Did) [you/(SP)] get any medicine prescribed by a doctor or other health
professional in a telephone call to a drugstore or pharmacy [since (REFERENCE DATE/UTILDATE)/between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)]?
[INLCUDE ALL PRESCRIBED MEDICINES 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.]

PM3PMMEDS

BOX PMA3

routing

PM5A

no entry

IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN ASKED IN THE CURRENT ROUND, GO
TO PM5A - PM3PMMEDS.
ELSE GO TO PM6 - MEDICINE_PM3.
It would be helpful if I could look at any medicine bottle(s), container(s), or bag(s) that you have so that I can
spell the medicine name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same information for all of the medicines [you/(SP)]
obtained since the last interview, if you’d like to get those bottles, too.

(01) ADD ANOTHER
(02) ALL DONE
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Prescribed Medicine Utilization (PMQ)
Variable Name
MEDICINE_PM3

MR Screen Name
PM6

Question type
roster

Question text/description
[AT TOP OF SCREEN DISPLAY LINK TO PRESCRIBED MEDICINE LOOKUP WITH LABEL "Search Medicine"]

Code list
(01) CONTINUOUS ANSWER

Please tell me the names of these medicines.
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.

[DISPLAY MEDICINE ROSTER AS RESPONSE OPTIONS:
1. [MEDICINE 1]
2. [MEDICINE 2]
…
N. [MEDICINE N]
N+1. ADD ANOTHER
[DISPLAY MEDICINE NAME AND STRENGTH FOR
EACH.

[DISPLAY ROSTER WITH ALL MEDICINES FROM PRIOR ROUNDS (WHERE EVENT.EVNTTYPE='PM' AND
EVNTDFLG^=1)]
DISPLAY MEDICINE NAME (EVENT.PMEDNAME) AND STRENGTH (EVENT.PRMSTRUNI)

IF NO EXISTING MEDICINES DISPLAY "NO MEDICINES
LISTED"]
PMEDNAME

PM6

verbatim

PMSTRUNI
ADDP

PM6
PM6AA

verbatim
roster

BOX PM1

routing

PM6A

grid

BOX PM1A

routing

RXNOFILL

PM6AB

list

RXDELAY

PM6AB

list

RXSKIP

PM6AB

list

RXDOSE

PM6AB

list

GETNUM

What is the name of the medicine?
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
[PRESCRIPTION MEDICINE LOOKUP CALLED FROM THIS SCREEN]
STRENGTH:
[DISPLAY MEDICINE ROSTER]

(01) ADD ANOTHER
(02) ALL DONE

IF SP REPORTED AT LEAST ONE PRESCRIPTION MEDICINE IN THE CURRENT ROUND UTILIZATION THAT DOES
NOT HAVE NUMBER OF PURCHASES ENTERED, GO TO PM6A - GETNUM.
ELSE GO TO PM17 - PMMORE.
IF ALL MEDICINES ARE NOT LISTED, USE "PREVIOUS PAGE" AND ADD THE MEDICINE TO THE ROSTER. REFER (01) CONTINUOUS ANSWER
TO STATEMENTS OR RECEIPTS, IF AVAILABLE.
(-8) DON'T KNOW
(-9) REFUSED
How many times [since (REFERENCE DATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)] did [(you/(SP)] obtain (MEDICINE NAME)]]?
IF AT LEAST ONE PRESCRIPTION MEDICINE DISPLAYED AT PM6A HAS NUMBER OF PURCHASES > 0 OR EQUAL
TO DK OR RF, GO TO RXNOFILL
ELSE GO TO PM17 - PMMORE.
SHOW CARD PM1
(01) OFTEN
Please think about the medicines you have obtained [since (REFERENCE DATE/UTILDATE)/between
(02) SOMETIMES
(REFERENCE DATE) and (ENDUTILD)], including [READ MEDICINE NAME(S) BELOW.] [Since (REFERENCE
(03) NEVER
DATE/UTILDATE)/Between (REFERENCE DATE) and ENDUTILD], how often did [you/(SP)] do any of the
(-8) DON'T KNOW
following things for these medicines. Did [you/(SP)] often, sometimes, or never…
(-9) REFUSED
decide not to fill or refill a prescription because the medicine cost too much?
([Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and ENDUTILD], how often did [you/(SP)] (01) OFTEN
do any of the following things for these medicines. Did [you/(SP)] often, sometimes, or never…)
(02) SOMETIMES
(03) NEVER
delay getting a prescription filled or refilled because the medicine cost too much?
(-8) DON'T KNOW
(-9) REFUSED
([Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and ENDUTILD], how often did [you/(SP)] (01) OFTEN
do any of the following things for these medicines. Did [you/(SP)] often, sometimes, or never…)
(02) SOMETIMES
(03) NEVER
skip doses to make the medicine last longer?
(-8) DON'T KNOW
(-9) REFUSED
([Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and ENDUTILD], how often did [you/(SP)] (01) OFTEN
do any of the following things for these medicines. Did [you/(SP)] often, sometimes, or never…)
(02) SOMETIMES
(03) NEVER
take smaller doses to make the medicine last longer?
(-8) DON'T KNOW
(-9) REFUSED

Prescribed Medicine Utilization (PMQ)
Variable Name
NAVIGATOR

MR Screen Name
PM6A_IN

Question type
instance navigator

Question text/description

BOX PM1A-1

routing

PM6A1

yes/no

BOX PM1AA

routing

PMSATHMO

PM6B

yes/no

IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A. IN THE CURRENT ROUND OR ANY
PREVIOUS ROUND), GO TO PM6A1 - PMSATVA.
ELSE GO TO BOX PM1AA.
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 A PRIVATE MANAGED CARE PLAN ANYTIME
DURING THE CURRENT ROUND, GO TO PM6B - PMSATHMO.
ELSE GO TO PMINTROB - PMINTB.
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.]

PMINTB

PMINTROB

no entry

PMBOTTLE

BOX PM1B
PM8

code one

BOX PM1B-1

routing

PM8AA

yes/no

PMSATVA

SAMEFSAM

[ASK R TO GET BOTTLES AND/OR STATEMENTS IF YOU HAVE NOT ALREADY DONE SO.]
[Now] I need to ask you a few [more] questions about the (MEDICINE NAME).
GO TO PM8 - PMBOTTLE.
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.

Code list
(01) ITEM SELECTED IN INSTANCE NAVIGATOR
(02) CONTINUE INTERVIEW SELECTED

(01) YES
(02) NO
(03) NO BUT R CAN ANSWER QUESTIONS
(-8) DON'T KNOW
(-9) REFUSED

IF (SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS ROUND AND THE PREVIOUS ROUND
FORM WAS ASKED AND DID NOT EQUAL DK) AND (SP REPORTED THE PRESCRIPTION MEDICINE IN THE
PREVIOUS ROUND AND THE PREVIOUS ROUND STRENGTH WAS ASKED AND DID NOT EQUAL DK) AND ((SP
REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS ROUND AND THE PREVIOUS ROUND NUMBER
WAS ASKED AND DID NOT EQUAL DK) OR (SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS
ROUND AND THE PREVIOUS ROUND AMOUNT WAS ASKED AND DID NOT EQUAL DK)), GO TO PM8AA SAMEFSAM.
IF SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS ROUND AND THE PREVIOUS ROUND FORM
WAS ASKED AND DID NOT EQUAL DK, GO TO PM8A - SAMEFORM.
ELSE GO TO BOX PM1B-2A.
CODE "YES" WITHOUT ASKING IF STATEMENT, RECEIPT, BOTTLE OR BAG IS PRESENT AND FORM, STRENGTH (01) YES
AND AMOUNT ARE THE SAME AS IN THE PREVIOUS INTERVIEW.
(02) NO
At the time of the last interview, [you/(SP)] purchased (MEDICINE NAME) in the form of (MEDICINE FORM). (-8) DON'T KNOW
(-9) REFUSED
The strength of [each pill/each suppository/each patch/the (STRENGTH MEDICINE FORM)] was [READ
STRENGTH BELOW].
(STRENGTH 1)
(STRENGTH 2)
[The amount of the (MEDICINE FORM) in the container when it was obtained was (PREVIOUS ROUND
MEDICINE AMOUNT)./The number of (MEDICINE FORM) in the container when it was obtained was
(PREVIOUS ROUND NUMBER).]
Is this medicine in the same strength, form and amount?
CODE "NO" UNLESS STRENGTH, FORM AND AMOUNT EXACTLY MATCH PREVIOUS ROUND.

Prescribed Medicine Utilization (PMQ)
Variable Name
SAMEFORM

PMFORM

MR Screen Name
PM8A

Question type
yes/no

BOX PM1B-2

routing

BOX PM1B-2A

routing

PMINTROC

no entry

PM9

code one

Question text/description
CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT, BOTTLE OR BAG IS PRESENT AND FORM IS SAME AS
PREVIOUS INTERVIEW.
(I would like to record what is different about this medicine.)
At the time of the last interview, [you/(SP)] purchased (MEDICINE NAME) in the form of (MEDICINE FORM).
Is this medicine in the same form?
IF SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS ROUND AND THE PREVIOUS ROUND
STRENGTH WAS ASKED AND DID NOT EQUAL DK, GO TO PM9A - SAMESTRN.
ELSE GO TO PM10 - STRNUNIT.
IF PM8 - PMBOTTLE=1/Yes, GO TO PMINTROC - PMINTC.
ELSE GO TO PM9 - PMFORM.
COMPLETE PM9 -- PM16 USING INFORMATION FROM STATEMENT, RECEIPT, MEDICINE BOTTLE OR
CONTAINER. IF THERE IS MORE THAN ONE FOR THE SAME MEDICINE, USE THE MOST RECENT CONTAINER.
IN WHAT FORM IS THE MEDICINE?
[IF THE CONTAINER INDICATES "PADS", SELECT THE CATEGORY FOR "PATCHES'.]

PMFORMOS
SAMESTRN

PM9
PM9A

text
yes/no

Code list
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

OTHER (SPECIFY)
CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT, BOTTLE OR BAG IS PRESENT AND STRENGTH IS
SAME AS PREVIOUS INTERVIEW.
At the time of the last interview, the strength of [each pill/each suppository/each patch/the (MEDICINE
FORM)] was [READ STRENGTH BELOW].

(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) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(STRENGTH 1)
(STRENGTH 2)

STRNUNIT

PM10

quantity unit

Is this medicine in the same strength?
WHAT IS THE STRENGTH OF [EACH PILL/EACH SUPPOSITORY/EACH PATCH/THE (MEDICINE FORM)]?
IF COMPOUND MEDICINE: ENTER STRENGTH OF 1ST MEDICINE, THEN CHECK THE BOX BELOW.

STRNUNOS
STRNNUM
STRNPER

PM10
PM10
PM10

text
numeric
numeric

OTHER (SPECIFY)

(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 DO NOT DISPLAY.
(-8) Don't Know
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER

Prescribed Medicine Utilization (PMQ)
Variable Name
STRNUNIT96

MR Screen Name
PM10

Question type

Question text/description
ENTER THE NAME OF THE 2ND MEDICINE IN THE COMPOUND IN THE BOX BELOW

BOX PM1B-3

routing

STRNUNI2

PM10B

quantity unit

IF PM10 - STRNUNIT96 = 1/Compound, GO TO PM10B - STRNUNI2.
ELSE GO TO BOX PM1B-4.
WHAT WAS THE STRENGTH OF THE 2ND MEDICINE IN THE COMPOUND?

STRNUNO2
STRNNUM2
STRNPER2

PM10B
PM10B
PM10B
BOX PM1B-4

text
numeric
numeric
routing

OTHER (SPECIFY)

TABNUM

PM11

numeric

HOW MANY [PILLS/SUPPOSITORIES/PATCHES] WERE IN THE CONTAINER WHEN IT WAS OBTAINED?

BOX PM1C

routing

PM12
PM12

numeric
code one

IF PRESCRIPTION MEDICINE FORM IS PILLS OR SUPPOSITORIES AND PM11 - TABNUM = DK, GO TO PM12 TABSADAY.
ELSE GO TO BOX PM2.
HOW MANY [PILLS/SUPPOSITORIES] ARE TO BE TAKEN IN A DAY?

BOX PM1D

routing

TABTAKE

PM13

numeric

TABTAKE96

PM13

code one

BOX PM1E

routing

TAKEUNIT

PM14

quantity unit

TAKENUM
SAMEAMNT

PM14
PM15A

numeric
yes/no

TABSADAY
TABSADAY95

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

IF PM12 - TABSADAY = DK, GO TO BOX PM2.
ELSE IF PM12 - TABSADAY95 = 2/TakeAsNeeded, GO TO PM13 - TABTAKE.
ELSE GO TO PM14 - TAKEUNIT.
How many (pills/suppositories) (do/did/does) [you/(SP)] usually take in a day?

IF PM13 - TABTAKE96 = 1/DontTakeEveryDay, GO TO BOX PM2.
ELSE GO TO PM14 - TAKEUNIT.
HOW MANY DAYS OR WEEKS WAS THE MEDICINE TO BE TAKEN?

Code list
(01) COMPOUND/MORE THAN ONE MEDICINE
COMBINED
(-7) EMPTY

(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 DO NOT DISPLAY.
(-8) Don't Know
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER

(01) CONTINUOUS ANSWER
(-8) DON'T KNOW

(01) CONTINUOUS ANSWER
(01) LESS THAN WHOLE
(02) TAKE AS NEEDED
(-7) Empty

(01) CONTINUOUS ANSWER
(-7) EMPTY
(-8) DON'T KNOW
(01) DON'T TAKE EVERY DAY
(-7) EMPTY

(01) DAYS
(02) WEEKS
[IF THE BOTTLE SAYS TO TAKE A CERTAIN DOSE OF THE MEDICINE DAILY WITHOUT GIVING A TIME FRAME (03) TAKE UNTIL GONE
(E.G., “TAKE 2 PILLS DAILY”), SELECT “TAKE EVERY DAY”.]
(04) TAKE AS NEEDED
(05) TAKE EVERY DAY
(-8) DON'T KNOW
(01) CONTINUOUS ANSWER
CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT, BOTTLE OR BAG IS PRESENT AND AMOUNT IS SAME (01) YES
AS PREVIOUS INTERVIEW.
(02) NO
At the time of the last interview, the amount of the (PREVIOUS ROUND MEDICINE FORM) was (PREVIOUS
(-8) DON'T KNOW
ROUND MEDICINE AMOUNT). Is this medicine in the same amount?
(-9) REFUSED

Prescribed Medicine Utilization (PMQ)
Variable Name
AMTUNIT

MR Screen Name
PM16

Question type
quantity unit

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.]

text
numeric
routing
code one

OTHER (SPECIFY)

NOFILLED

PM16
PM16
BOX PM2
PM16A1

DELAYFIL

PM16A

code one

SKIPDOSE

PM16B

code one

CUTDOSE

PM16C

code one

BOX PM3
BOX PM3A

routing
routing

PM17

yes/no

AMTUNOS
AMTNUM

PMMORE

BOX PMEND

routing

GO TO BOX PM3.
SHOW CARD PM1
Since (REFERENCE DATE), how often did [you/(SP)] decide not to fill or refill (MEDICINE) because it cost too
much?

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

(01) OFTEN
(02) SOMETIMES
(03) NEVER
(-8) DON'T KNOW
(-9) REFUSED
SHOW CARD PM1
(01) OFTEN
Since (REFERENCE DATE), how often did [you/(SP)] delay filling or refilling a prescription for (MEDICINE
(02) SOMETIMES
NAME) because it cost too much?
(03) NEVER
(-8) DON'T KNOW
(-9) REFUSED
SHOW CARD PM1
(01) OFTEN
Since (REFERENCE DATE), how often did [you/(SP)] skip doses of (MEDICINE NAME) to make the medicine
(02) SOMETIMES
last longer?
(03) NEVER
(04) NEVER TOOK THE MEDICINE AT ALL
[IF THE RESPONSE IS "NEVER", PROBE: Do you mean that [you/(SP)] never skipped doses of the medicine to (-8) DON'T KNOW
make it last longer, or that (you/he/she) never took the medicine at all?]
(-9) REFUSED
SHOW CARD PM1
(01) OFTEN
Since (REFERENCE DATE), how often did [you/(SP)] take smaller doses of (MEDICINE NAME) to make the
(02) SOMETIMES
medicine last longer?
(03) NEVER
(04) NEVER TOOK THE MEDICINE AT ALL
[IF THE RESPONSE IS "NEVER", PROBE: Do you mean that [you/(SP)] never took smaller doses of the
(-8) DON'T KNOW
medicine to make it last longer, or that (you/he/she) never took the medicine at all?]
(-9) REFUSED
GO TO PM6A_IN - NAVIGATOR.
IF CURRENTLY ADMINISTERING ST, GO TO BOX ST43.
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS43.
ELSE GO TO PM17 - PMMORE.
([NO MEDICINES HAVE BEEN REPORTED FOR (SP) FOR THE CURRENT REFERENCE PERIOD/THE NAMES OF
(01) YES
ALL MEDICINES REPORTED FOR THE CURRENT REFERENCE PERIOD ARE DISPLAYED BELOW.])
(02) NO
[REVIEW THE INFORMATION BELOW WITH THE RESPONDENT. ASK, OR CODE AS APPROPRIATE IF R
ALREADY INDICATED: Are there any (more) medicines since (REFERENCE DATE/UTILDATE) that we haven't
talked about?]
GO TO NEXT SECTION