Cms-p-0015a Mcbs

Medicare Current Beneficiary Survey (MCBS)

R69_FQM

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

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Medicare Current Beneficiary Survey

Section Specifications for FQM

Round 69

FACILITY QUESTIONNAIRE MISSING DATA

Created on 5/9/2014 6:10:39 PM

BOX FQMBEG



Box Instructions

GO TO FQMISS1 - FQMISSNG.

FQMISS1 Code 1



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 FQM1



Box Instructions

IF (FQ1A - PLACNAME = DK OR RF) AND (FQM1A - MSFNAME = DK, EMPTY, OR NULL), GO TO FQM1A - MSFNAME.

ELSE GO TO BOX FQM2.

FQM1A Yes/No



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



FQM1B Text



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 FQM2



Box Instructions

IF (FQ2 - FADDROK = DK OR RF) AND (FQM2A - MSFADDR = DK, EMPTY, OR NULL), GO TO FQM2A - MSFADDR.

ELSE GO TO BOX FQM2A1.

FQM2A Yes/No



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 =
PreloadPLAC.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 =
PreloadPLAC.ADDRSTAT

ADDRZIP

If FQM2A - MSFADDR = 1/Yes or RF then PLAC.ADDRZIP = PreloadPLAC.ADDRZIP



FQM2B Address



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 FQM2A1



Box Instructions

IF (FQ4 - MADDROK = RF) AND (FQM2C - MSMADDR = EMPTY, OR NULL), GO TO FQM2C - MSMADDR.

ELSE GO TO BOX FQM3.

FQM2C Yes/No



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:
If PreloadFQ.MAILADDR <> EMPTY, then FQ.MAILADDR = PreloadFQ.MAILADDR. Else FQ.MAILADDR = FQ.ADDRESS

MAILCITY

If FQ4-MADDROK = 1/Yes or RF:
If PreloadFQ.MAILADDR <> EMPTY, then FQ.MAILCITY = PreloadFQ.MAILCITY. Else FQ.MAILCITY = FQ.ADDRCITY

MAILSTAT

If FQ4-MADDROK = 1/Yes or RF:
If PreloadFQ.MAILADDR <> EMPTY, then FQ.MAILSTAT = PreloadFQ.MAILSTAT. Else FQ.MAILSTAT = FQ.ADDRSTAT

MAILZIP

If FQ4-MADDROK = 1/Yes or RF:
If PreloadFQ.MAILADDR <> EMPTY, then FQ.MAILZIP = PreloadFQ.MAILZIP. Else FQ.MAILZIP = FQ.ADDRZIP



FQM2D Text



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 FQM3



Box Instructions

IF (FQ3 - FADMNOK = DK OR RF) AND (FQM3A - MSFADMN = DK, EMPTY, OR NULL), GO TO FQM3A - MSFADMN.

ELSE GO TO BOX FQM4.

FQM3A Yes/No



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





FQM3B Text



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 FQM4



Box Instructions

IF (FQ5 - FPHONOK = DK OR RF) AND (FQM4A - MSFPHON = DK, EMPTY, OR NULL), GO TO FQM4A - MSFPHON.

ELSE GO TO BOX FQM5.

FQM4A Yes/No



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



FQM4B Numeric



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 FQM5



Box Instructions

IF (FA1 - PLACTYP1 = RF) AND (FQM5A - MSPLACTY = EMPTY OR NULL), GO TO FQM5A - MSPLACTY.

ELSE GO TO BOX FQM6.

FQM5A Code 1



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.
Else PLAC.PLACTPOS = EMPTY.



BOX FQM6



Box Instructions

IF (FA12 - BEDSNUM = DK OR RF) AND (FQM6A - MSBEDSNU = DK, EMPTY, OR NULL), GO TO FQM6A - MSBEDSNU.

ELSE GO TO BOX FQM7.

FQM6A Numeric



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 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.

FQM7A Yes/No



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 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.

FQM8A Yes/No



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 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.

FQM9A Yes/No



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 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.

FQM10A Code 1



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 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.

FQM11A Code 1



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 FQMCOMP



Box Instructions

GO TO FQMEND - FQMSEND.

FQMEND Code 1



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 FQMEND



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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorRyan Hubbard
File Modified0000-00-00
File Created2021-01-21

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