Cms-p-0015a Mcbs

Medicare Current Beneficiary Survey

Section Specifications for BQM

Round 69

BACKGROUND QUESTIONNAIRE MISSING DATA

Created on 5/9/2014 6:07:32 PM

BOX BQMBEG

Box Instructions

GO TO BQMISS1 - BQMISSNG.

BQMISS1 Code 1

Question Text

THE FOLLOWING ITEMS ARE MISSING FROM BQ. CONFIRM THAT RESPONDENT CAN ANSWER AT LEAST ONE OF THESE ITEMS.

PRESS "1" TO CONTINUE.

Field 1: BQMISSNG

Field 1 Routing

Value	Label	Route
1	CONTINUE	BOX BQM1

Other Programming Instructions

Report Display

Report display instructions:
If BQ11A - BQRACE = DK or RF and BQM1A - BQMRACE = DK, EMPTY, or NULL, then display "WHAT IS (SP's) RACE?".
If BQ13 - BMRJAN = DK or RF and BQM2A - BQMMARTL = DK, EMPTY, or NULL, then display "WHAT IS (SP's) MARITAL STATUS?".


Report display:
(WHAT IS (SP's) RACE?)
(WHAT IS (SP's) MARITAL STATUS?)

BOX BQM1

Box Instructions

IF (BQ11A - BQRACE = DK OR RF) AND (BQM1A - BQMRACE = DK, EMPTY OR NULL), GO TO BQM1A - BQMRACE.

ELSE, GO TO BOX BQM2.

BQM1A Code All

Question Text

SHOW CARD BQ1A

Please look at this card and tell me what (is/was) (SP's) race.

SELECT ALL THAT APPLY, OR ENTER "95" R NEVER WILL KNOW.
SEPARATE RESPONSES BY USING THE SPACEBAR.

Field 1: BQMRACE

Field 1 Routing

Value	Label	Route
1	AMERICAN INDIAN OR ALASKA NATIVE	BOX BQM1A
2	ASIAN	BOX BQM1A
3	BLACK OR AFRICAN AMERICAN	BOX BQM1A
4	NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER	BOX BQM1A
5	WHITE	BOX BQM1A
91	ANOTHER RACE	BQM1A - BQMRACOS
95	R NEVER WILL KNOW	BOX BQM2
	Don't Know	BOX BQM2
	Refused	BOX BQM2

Field 2: BQMRACOS

ANOTHER RACE (SPECIFY)

Field 2 Routing

Value	Label	Route
1	[Continuous answer.]	BOX BQM1A

BOX BQM1A

Box Instructions

IF BQM1A-BQMRACE INCLUDES 2/Asian, GO TO BQM1AB - BMRACASD.

ELSE GO TO BOX BQM1B.

BQM1AB Code All

Question Text

SHOW CARD BQ1B.

Looking at this card, (is/was) (SP) Asian Indian, Chinese, Filipino,
Japanese, Korean, Vietnamese or some other Asian group?

You can choose more than one group.

CHECK ALL THAT APPLY.

Field 1: BMRACASD

Field 1 Routing

Value	Label	Route
1	ASIAN INDIAN	BOX BQM1B
2	CHINESE	BOX BQM1B
3	FILIPINO	BOX BQM1B
4	JAPANESE	BOX BQM1B
5	KOREAN	BOX BQM1B
6	VIETNAMESE	BOX BQM1B
91	OTHER ASIAN GROUP	BQM1AB - BMRACAOS
	Don't Know	BOX BQM1B
	Refused	BOX BQM1B

Field 2: BMRACAOS

OTHER ASIAN GROUP (SPECIFY)

Field 2 Routing

Value	Label	Route
1	[Continuous answer.]	BOX BQM1B

BOX BQM1B

Box Instructions

IF BQM1A-BQMRACE INCLUDES 4/NativeHawaiianOrOtherPacificIslander, GO TO BQM1AC - BMRACPID.

ELSE GO TO BOX BQM2.

BQM1AC Code All

Question Text

SHOW CARD BQ1C.

Looking at this card, (is/was) (SP) Native Hawaiian, Guamanian
or Chamorro, Samoan, or some other Pacific Islander group?

You can choose more than one group.

CHECK ALL THAT APPLY.

Field 1: BMRACPID

Field 1 Routing

Value	Label	Route
1	NATIVE HAWAIIAN	BOX BQM2
2	GUAMANIAN OR CHAMORRO	BOX BQM2
3	SAMOAN	BOX BQM2
91	OTHER PACIFIC ISLANDER GROUP	BQM1AC - BMRACPOS
	Don't Know	BOX BQM2
	Refused	BOX BQM2

Field 2: BMRACPOS

OTHER PACIFIC ISLANDER GROUP (SPECIFY)

Field 2 Routing

Value	Label	Route
1	[Continuous answer.]	BOX BQM2

BOX BQM2

Box Instructions

IF (BQ13 - BMRJAN = DK OR RF) AND (BQM2A - BQMMARTL = DK, EMPTY OR NULL, GO TO BQM2A - BQMMARTL.

ELSE GO TO BOX BQMEND.

BQM2A Code 1

Question Text

(Is/was) (SP) married, widowed, divorced, separated, or never married?

IF R NEVER WILL KNOW, ENTER "95".

Field 1: BQMMARTL

Field 1 Routing

Value	Label	Route
1	MARRIED	BQMEND - BQMSEND
2	WIDOWED	BQMEND - BQMSEND
3	DIVORCED	BQMEND - BQMSEND
4	SEPARATED	BQMEND - BQMSEND
5	NEVER MARRIED	BQMEND - BQMSEND
95	R NEVER WILL KNOW	BQMEND - BQMSEND
	Don't Know	BQMEND - BQMSEND
	Refused	BQMEND - BQMSEND

BQMEND Code 1

Question Text

YOU HAVE REACHED THE END OF THE SECTION FOR BACKGROUND QUESTIONNAIRE MISSING DATA.

PRESS "1" TO RETURN TO FACILITY NAVIGATION SCREEN.

Field 1: BQMSEND

Field 1 Routing

Value	Label	Route
1	CONTINUE	BOX BQMEND

BOX BQMEND

Box Instructions

GO TO NAVIGATOR

Other Programming Instructions

Variable Name	Assignment Instructions
BQMDDISP	If BQM1A - BQMRACE <> DK and BQM2A - BQMMARTL <> DK, then BQMDDISP = 96/Complete. Else BQMDDISP = 3/StartedNotComplete.

Design Notes

Any DK responses to the following variables should be set to EMPTY upon return to the Navigator:
BQM1A - BQMRACE
BQM2A - BQMMARTL