Cms-p-0015a Mcbs

Medicare Current Beneficiary Survey (MCBS)

R69_PMF

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

OMB: 0938-0568

Document [docx]
Download: docx | pdf




























Medicare Current Beneficiary Survey

Section Specifications for PMF

Round 69

PRESCRIBED MEDICINES (FACILITY)

Created on 5/9/2014 6:13:18 PM

BOX PMBEG



Box Instructions

GO TO PM1PRE - PM1PRECT.

Other Programming Instructions

Background Variable Assignments

PMARRAY:

If PMDISP = 92/Ready then load all months needing PM data collected into PM array using the following logic:

The first month = PERS.PMREFBEG month. If PERS.PMREFBEG <> PERS.PMREFEND then:

If PERS.PMREFEND = PERS.PMREFBEG + 1 month then load PERS.PMREFEND month.

Else:

If PERS.PMREFBEG < year and month of PERS.RHREFBEG then
load all remaining months after PERS.PMREFBEG month having PreloadPM.ORIGSTAT = 2/RetrieveNextRound.

**DO NOT LOAD preload MONTH IF PreloadPM.ORIGSTAT <> 2/RetrieveNextRound. THAT MONTH IS ONLY IN PRELOAD TO OBTAIN ACTIVE MEDICINES**

If last month loaded from preload <> PERS.PMREFEND then load month = year and month of PERS.RHREFBEG.

If month loaded <> PERS.PMREFEND then load each additional month where SP was in the target facility for at least one day starting with year and month of PERS.RHREFBEG until month loaded = PMREFEND.

If eligible month before readmission not collected then load month = STAYEYY + STAYEMM from last PreloadSTAY.
__________________________________
Setting field values for each month loaded:

If month loaded has PreloadPM.ORIGSTAT= 2, set the following fields from preload record where PM.MonthData[x].MonthID = PreloadPM.PREFYYMM:

PM.MonthData[x].ORIGSTAT = PreloadPM.ORIGSTAT
PM.MonthData[x].PREFRNDC = PreloadPM.PREFRNDC

and set PM.MonthData[x].loadMonth = 1/Yes



Else if month loaded does not exist in PreloadPM set the following fields:

PM.MonthData[x].loadMonth = 1/Yes
PM.MonthData[x].PREFRNDC = current round

Variable Name

Assignment Instructions

PMDISP

PMDISP = 93/Breakoff



Design Notes

PM BLAISE DATA STORAGE:

IF THIS IS THE FIRST ROUND PM DATA HAS BEEN COLLECTED FOR THIS SP, CONSTRUCT 36 MONTH PM MASTER ARRAY STARTING WITH MONTH AND YEAR OF PreloadSP.PMBASDAT.

AVAILABLE PM MONTHS FOR THE ROUND SHOULD BE DETERMINED BASED ON LOGIC IN PM SECTION. CURRENT ROUND PM COLLECTION SHOULD BE STORED IN THE CORRESPONDING MONTH IN PM MASTER ARRAY.

PM1PRE Code 1



Question Text

The following questions are about all of the medicines prescribed for (SP) in (FACILITY) [in (PM REFERENCE START MONTH)/between (PM REFERENCE START MONTH) and (PM REFERENCE END MONTH)].

PRESS "1" TO CONTINUE.

Field 1: PM1PRECT

Field 1 Routing

Value

Label

Route

1

CONTINUE

BOX PM1AA





Other Programming Instructions

Report Display

Display report above question text.
Display all stays where STAY.XSTPLAC <> 000 that were reported for this SP in
chronological order by start date of the stay.
Report header: STAY TIMELINE
Report layout:
Column 1, header="Place Name", display PLAC.PLACNAME of
PLAC where PLAC.PLACNUM = STAY.XSTPLAC.
Column 2, header="Start Date", display
STAY.STAYSMM+STAY.STAYSDD+STAY.STAYSYY in month, day
year format.
Column 3, header="End Date", display
STAY.STAYEMM+STAY.STAYEDD+STAY.STAYEYY in month, day
year format.
Column 4, header="Stay Type", display STAY.STAYCLAS.

Background Variable Assignments

Variable Name

Assignment Instructions

PMINDEX

If Pmindex = EMPTY, PMindex = SPPreload.LASTPMED.



BOX PM1AA



Box Instructions

SET PM REFERENCE MONTH TO FIRST/NEXT NON-COMPLETE MONTH AND GO TO PM1BB - CHTRXAVL.

PM1BB Code 1



Question Text

Is the (PM REFERENCE MONTH) prescribed medicine chart currently available for (SP)?

[IF "NO", PROBE TO DETERMINE FUTURE AVAILABILITY.]

Field 1: CHTRXAVL

Field 1 Routing

Value

Label

Route

0

NO, BUT WILL BE AVAILABLE THIS ROUND

BOX PM10

1

YES, AVAILABLE NOW

PM1B - CHTRXADM

95

NO, WILL NOT BE AVAILABLE THIS ROUND

BOX PM10

96

NO, WILL NEVER BE AVAILABLE

BOX PM10

97

RETURN TO NAVIGATOR

BOX PMEND





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PREFSTAT

If PM1BB - CHTRXAVL = 95/NoWillNot BeAvailThisRound, PREF.PREFSTAT = 2/RetrieveNextRound
Else if PM1BB - CHTRXAVL = 96/NoWillNeverBeAvail, PREF.PREFSTAT = 3/NeverWillKnow

CHTAVRND

If PM1BB - CHTRXAVL = 1/YesAvailNow, then PREF.CHTAVRND = CURRENT ROUND.



PM1B Yes/No



Question Text

Does the chart show any prescribed medicines administered in (PM REFERENCE MONTH)?

PRESS F1 FOR EXPLANATION OF "ADMINISTERED".

Field 1: CHTRXADM

Field 1 Routing

Value

Label

Route

0

NO

PMMTHFIN - MONTHFIN

1

YES

BOX PM1A





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PREFSTAT

If PM1B-CHTRXADM = 0/No, then PREF.PREFSTAT = 1/DataCollected



BOX PM1A



Box Instructions

IF THERE WERE ACTIVE MEDICINES IN THE MOST RECENT MONTH FOR WHICH PM DATA WERE COLLECTED, BUILD MOST RECENT PRESCRIBED MEDICINE LIST AND GO TO BOX PM1C.

ELSE GO TO PM2 - PMNAMSEL.

Other Programming Instructions

Background Variable Assignments

If there were active medicines in the most recent month for which PM data were collected and PM reference month is the first PM reference month collected this round, set the following variables in the PrevMedTable array for the PM reference month from PreloadPM:

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMEDNAME = PreloadPM.PMEDNAME
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMEDRNDC = PreloadPM.PMEDRNDC
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMFORM = PreloadPM.PMFORM
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRRED = PreloadPM.PMSTRRED
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMFRM = PreloadPM.PMFRM
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMFRMOS = PreloadPM.PMFRMOS
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRN1 = PreloadPM.PMSTRN1
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRU1 = PreloadPM.PMSTRU1
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTROS1 = PreloadPM.PMSTROS1
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRN2 = PreloadPM.PMSTRN2
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRU2 = PreloadPM.PMSTRU2
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTROS2 = PreloadPM.PMSTROS2
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRN3 = PreloadPM.PMSTRN3
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRU3 = PreloadPM.PMSTRU3
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTROS3 = PreloadPM.PMSTROS3
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEN = PreloadPM.PMDOSEN
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEU = PreloadPM.PMDOSEU
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEOS = PreloadPM.PMDOSEOS
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEEH = PreloadPM.PMDOSEEH
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEEW = PreloadPM.PMDOSEEW
PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEEW = PreloadPM.PMDOSEQW




Else if there were active medicines in the most recent month for which PM data were collected and PM reference month is not the first PM reference month collected this round, set the following variables in the PrevMedTable array for the PM reference month from MedicationData Table for most recent month for which PM data were collected:

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMEDNAME = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMEDNAME

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMEDRNDC = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMEDRNDC

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMFORM = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMFORM

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMEDSTRENGTH = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMEDSTRENGTH

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMEDUNIT = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMEDUNIT

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRRED = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRRED

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMFRM = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMFRM

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMFRMOS = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMFRMOS

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRN1 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRN1

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRU1 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRU1

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTROS1 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTROS1

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRN2 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRN2

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRU2 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRU2

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTROS2 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTROS2

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRN3 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRN3

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTRU3 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTRU3

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMSTROS3 = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMSTROS3

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEN = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMDOSEN

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEU = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMDOSEU

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEOS = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMDOSEOS

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEEH = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMDOSEEH

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEEW = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMDOSEEW

PM.MonthData[x].PrevMedsTable.PrevMeds[x].PMDOSEQW = PM.MonthData[x].MedicationDataTable.MedicationData[x].PMDOSEQW

BOX PM1C



Box Instructions

LOAD FIRST/NEXT ACTIVE MEDICINE AND GO TO PM1C - TIMEADMA.

Other Programming Instructions

Background Variable Assignments

Create XPRP record for first/next drug. And set the following vairables:

PM1C Numeric



Question Text

In (PM REFERENCE MONTH), what was the total number of times (FULL MEDICINE NAME) (FULL MEDICINE DOSAGE) was administered?

COUNT EACH TIME THE DRUG WAS GIVEN ON EACH DAY.

IF DRUG IS A TYPE OF INSULIN, ENTER "995" TO ENTER TOTAL NUMBER OF UNITS FOR THE MONTH.

IF DRUG NOT LISTED ON CHART - AS SPECIFIED, ENTER "999" FOR NUMBER OF TIMES.

Field 1: TIMEADMA

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

IF PM1C-TIMEADMA = 995, GO TO PM1C - UNITADMA. ELSE GO TO PM1C - DISCFLGA.


Don't Know

PM1C - DISCFLGA


Refused

PM1C - DISCFLGA





Field 2: UNITADMA

NUMBER OF UNITS?

Field 2 Routing

Value

Label

Route

1

[Continuous answer.]

PM1C - DISCFLGA


Don't Know

PM1C - DISCFLGA


Refused

PM1C - DISCFLGA





Field 3: DISCFLGA

DISCONTINUED?

Field 3 Routing

Value

Label

Route

0

NO

BOX PM1D

1

YES

BOX PM1D





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

TIMESADM

If PM1C - TIMEADMA <> 999, PrevData[x].PrevMeds.TIMESADM = PM1C - TIMEADMA

DISCFLG

If PM1C - DISCFLGA = 1/Yes, PrevData[x].PrevMeds.DISCFLG = 1/Yes. ELSE IF PM1C – DISCFLGA = 0/No, PrevData[x].PrevMeds.DISCFLG = 0/No.

DELFLG

If PM1C - TIMEADMA = 999, PrevData[x].PrevMeds.DELFLG = 1/Indicated

UNITSADM

If PM1C - TIMEADMA = 995, PrevData[x].PrevMeds.UNITSADM = PM1C - UNITADMA.



BOX PM1D



Box Instructions

IF THERE ARE ADDITIONAL ACTIVE MEDICINES IN THE MOST RECENT MONTH, GO TO BOX PM1C.

ELSE GO TO PM1CHK - PMGAPCHK.

PM1CHK Code 1



Question Text

AFTER COMPLETING ALL DRUG INFORMATION ENTER "1" TO CONTINUE.

Field 1: PMGAPCHK

Field 1 Routing

Value

Label

Route

1

CONTINUE

PM9 - NOMORERX





PM2 Code 1



Question Text

What was the name of the prescribed medicine administered to (SP)?

PRESS F1 FOR EXPLANATION OF "ADMINISTERED."

SELECT PRESCRIBED MEDICINE FROM LOOKUP OR SELECT "[DRUG NAME/STRENGTH NOT LISTED]" FROM LOOKUP.

Field 1: PMNAMSEL

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

BOX PM1





Other Programming Instructions

Background Variable Assignments

Create PMED record for this drug with the following and increment PMindex:

Variable Name

Assignment Instructions

PMEDNUM

PMED.PMEDNUM = next sequential PMED.PMEDNUM (PMindex +1)

PMEDRNDC

PMED.PMEDRNDC = CURRENT ROUND

PMNAME

PMED.PMNAME = PM2 - PMNAMSEL

PMFRMRED

PMED.PMFRMRED = RED BOOK FORM OF PM2 - PMNAMSEL (Form English Text)

PMSTRRED

PMED.PMSTRRED = RED BOOK STRENGTH OF PM2 - PMNAMSEL (Strength)

PMFORM

PMED.PMFORM = RED BOOK FORM TYPE OF PM2 - PMNAMSEL (Form Value)

PMINDEX

PMINDEX = PMINDEX+1



BOX PM1



Box Instructions

If "[DRUG NAME/STRENGTH NOT LISTED]" SELECTED AT PM2, GO TO PM2A - PMNAMADD.

ELSE GO TO PM5 - PMDOSEN.

Variable Name

Assignment Instructions

PMSELADD

If "[DRUG NAME /STRENGTH NOT LISTED]" selected at PM2 - PMNAMSEL, PMED.PMSELADD = 2/Added.
Else PMED.PMSELADD = 1/Selected



PM2A Text



Question Text

What was the name of the prescribed medicine administered to (SP)?

Field 1: PMNAMADD

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM3 - PMFRM





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PMNAME

PMED.PMNAME = PM2A - PMNAMADD



PM3 Code 1



Question Text

In what form was (PM2A MEDICINE NAME)?

Field 1: PMFRM

Field 1 Routing

Value

Label

Route

1

TABLET/CAPSULE/PILL

PM4A - PMSTRN1

2

LIQUID (ORAL)

PM4A - PMSTRN1

3

TOPICAL OINTMENT, CREAM, LOTION, DROPS

BOX PM2A

4

SUPPOSITORIES

PM4A - PMSTRN1

5

INHALANT, AEROSOL/SPRAY USED ORALLY

BOX PM2A

6

SHAMPOO, SOAP

BOX PM2A

7

INJECTION (BODY)

PM4A - PMSTRN1

8

INTRAVENOUS (IV)

PM4A - PMSTRN1

9

PATCHES

PM4A - PMSTRN1

10

TOPICAL GEL/JELLY

BOX PM2A

11

POWDER

BOX PM2A

91

OTHER

PM3 - PMFRMOS


Don't Know

PM4A - PMSTRN1


Refused

PM4A - PMSTRN1





Field 2: PMFRMOS

OTHER (SPECIFY)

Field 2 Routing

Value

Label

Route

1

[Continuous answer.]

PM4A - PMSTRN1





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PMFORM

PMED.PMFORM = PM3-PMFRM



PM4A Quantity Unit



Question Text

What was the strength of (PM2A MEDICINE NAME)?

IF NO STRENGTH SPECIFIED, ENTER 0 IN NUMBER FIELD AND SELECT "NO STRENGTH" IN UNITS.

IF A COMPOUND MEDICINE, ENTER 0 IN NUMBER FIELD AND SELECT "CO" IN UNITS.

Field 1: PMSTRN1

NUMBER

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM4A - PMSTRU1


Refused

BOX PM2A





Field 2: PMSTRU1

Display response options in the following order: 1, 2, 7, 3, 4, 8, 5, 6, 9, 95, 96, 91.

Field 2 Routing

Value

Label

Route

1

GR (GRAMS)

BOX PM2A

2

MG (MILLIGRAMS)

BOX PM2A

3

ML (MILLILITERS)

BOX PM2A

4

MG/ML (MILLIGRAMS/MILLILITER)

BOX PM2A

5

CC (CUBIC CENTIMETERS)

BOX PM2A

6

% (PERCENT)

BOX PM2A

7

MCG (MICROGRAMS)

BOX PM2A

8

MEQ (MILLIEQUIVALENTS)

BOX PM2A

9

U (UNITS)

BOX PM2A

91

OTHER

PM4A - PMSTROS1

95

NO STRENGTH

BOX PM2A

96

CO (COMBINATION DRUG)

PM4B - PMSTRN2


Don't Know

BOX PM2A


Refused

BOX PM2A





Field 3: PMSTROS1

OTHER (SPECIFY)

Field 3 Routing

Value

Label

Route

1

[Continuous answer.]

BOX PM2A





PM4B Quantity Unit



Question Text

What was the strength of the first compound medicine in (PM2A MEDICINE NAME)?

IF NO STRENGTH SPECIFIED, ENTER 0 IN NUMBER FIELD AND SELECT "NO STRENGTH" IN UNITS.

Field 1: PMSTRN2

NUMBER

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM4B - PMSTRU2


Refused

BOX PM2A





Field 2: PMSTRU2

Field 2 Routing

Value

Label

Route

1

GR (GRAMS)

PM4C - PMSTRN3

2

MG (MILLIGRAMS)

PM4C - PMSTRN3

3

ML (MILLILITERS)

PM4C - PMSTRN3

4

MG/ML (MILLIGRAMS/MILLILITER)

PM4C - PMSTRN3

5

CC (CUBIC CENTIMETERS)

PM4C - PMSTRN3

6

% (PERCENT)

PM4C - PMSTRN3

7

MCG (MICROGRAMS)

PM4C - PMSTRN3

8

MEQ (MILLIEQUIVALENTS)

PM4C - PMSTRN3

9

U (UNITS)

PM4C - PMSTRN3

91

OTHER

PM4B - PMSTROS2

95

NO STRENGTH

PM4C - PMSTRN3


Don't Know

PM4C - PMSTRN3


Refused

PM4C - PMSTRN3





Field 3: PMSTROS2

OTHER (SPECIFY)

Field 3 Routing

Value

Label

Route

1

[Continuous answer.]

PM4C - PMSTRN3





PM4C Quantity Unit



Question Text

What was the strength of the second compound medicine in (PM2A MEDICINE NAME)?

IF NO STRENGTH SPECIFIED, ENTER 0 IN NUMBER FIELD AND SELECT "NO STRENGTH" IN UNITS.

Field 1: PMSTRN3

NUMBER

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM4C - PMSTRU3


Refused

BOX PM2A





Field 2: PMSTRU3

Field 2 Routing

Value

Label

Route

1

GR (GRAMS)

BOX PM2A

2

MG (MILLIGRAMS)

BOX PM2A

3

ML (MILLILITERS)

BOX PM2A

4

MG/ML (MILLIGRAMS/MILLILITER)

BOX PM2A

5

CC (CUBIC CENTIMETERS)

BOX PM2A

6

% (PERCENT)

BOX PM2A

7

MCG (MICROGRAMS)

BOX PM2A

8

MEQ (MILLIEQUIVALENTS)

BOX PM2A

9

U (UNITS)

BOX PM2A

91

OTHER

PM4C - PMSTROS3

95

NO STRENGTH

BOX PM2A


Don't Know

BOX PM2A


Refused

BOX PM2A





Field 3: PMSTROS3

OTHER (SPECIFY)

Field 3 Routing

Value

Label

Route

1

[Continuous answer.]

BOX PM2A





BOX PM2A



Box Instructions

If PM3 - PMFRM = 8/Intravenous, GO TO PM7 - PMDOSEU.

ELSE GO TO PM5 - PMDOSEN.

PM5 Numeric



Question Text

[The next few questions ask about the dosage of (FULL MEDICINE NAME). As you know, dosage has two attributes -- the number of units (pills, injections, patches, and so on) of a particular strength of medicine to be received at one time and how often this number of units was to be received. First, let me ask about the number of units.]

What was a single dose of (FULL MEDICINE NAME)?

(PRESS F1 FOR EXPLANATION OF "DOSAGE".)

IF NO NUMBER OF UNITS, ENTER "96".

Field 1: PMDOSEN

NUMBER

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM7 - PMDOSEU


Refused

PM8 - TIMEADMB





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PM5LONG

FACR.PM5LONG = curent round



PM7 Code 1



Question Text

How often was this dose [of (DOSAGE NUMBER)] of (FULL MEDICINE NAME) prescribed to be administered?

Field 1: PMDOSEU

HOW OFTEN

Field 1 Routing

Value

Label

Route

1

QD (1 TIME PER DAY)

PM8 - TIMEADMB

2

BID (2 TIMES PER DAY)

PM8 - TIMEADMB

3

TID (THREE TIMES PER DAY)

PM8 - TIMEADMB

4

QID (4 TIMES PER DAY)

PM8 - TIMEADMB

5

QH (EVERY HOUR)

PM8 - TIMEADMB

6

Q4H (EVERY 4 HOURS)

PM8 - TIMEADMB

7

Q6H (EVERY 6 HOURS)

PM8 - TIMEADMB

8

Q8H (EVERY 8 HOURS)

PM8 - TIMEADMB

9

Q12H (EVERY 12 HOURS)

PM8 - TIMEADMB

10

Q_H (EVERY _ HOURS)

PM7A - PMDOSEEH

11

AC (BEFORE MEALS)

PM8 - TIMEADMB

12

PC (AFTER MEALS)

PM8 - TIMEADMB

13

QHS (DAILY AT BED TIME)

PM8 - TIMEADMB

14

QOD (EVERY OTHER DAY)

PM8 - TIMEADMB

15

PRN (STANDING ORDER, AS NECESSARY)

PM8 - TIMEADMB

16

BLANK

DO NOT DISPLAY.

17

OTO (ONE TIME ONLY)

PM8 - TIMEADMB

18

TIMES PER WEEK

PM7B - PMDOSEEW

19

Q_W (EVERY _ WEEKS)

PM7C - PMDOSEQW

91

OTHER

PM7 - PMDOSEOS


Don't Know

PM8 - TIMEADMB


Refused

PM8 - TIMEADMB





Field 2: PMDOSEOS

OTHER (SPECIFY)

Field 2 Routing

Value

Label

Route

1

[Continuous answer.]

PM8 - TIMEADMB





PM7A Numeric



Question Text

THIS MEDICINE WAS TO BE TAKEN EVERY…

Field 1: PMDOSEEH

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM8 - TIMEADMB





PM7B Numeric



Question Text

HOW MANY TIMES PER WEEK WAS THIS DOSE TO BE ADMINISTERED?

Field 1: PMDOSEEW

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM8 - TIMEADMB





PM7C Numeric



Question Text

THIS MEDICINE WAS TO BE TAKEN EVERY ______ WEEKS.

Field 1: PMDOSEQW

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

PM8 - TIMEADMB





PM8 Numeric



Question Text

In (PM REFERENCE MONTH), what was the total number of times (FULL MEDICINE DOSAGE) of (FULL MEDICINE NAME) was administered?

COUNT EACH TIME THE DRUG WAS GIVEN ON EACH DAY.

IF DRUG IS A TYPE OF INSULIN, ENTER "995" TO ENTER TOTAL NUMBER OF UNITS FOR THE MONTH.

Field 1: TIMEADMB

Field 1 Routing

Value

Label

Route

1

[Continuous answer.]

IF PM8-TIMEADMB = 995, GO TO PM8 - UNITADMB. ELSE GO TO PM8 - DISCFLGB.


Don't Know

PM8 - DISCFLGB


Refused

PM8 - DISCFLGB





Field 2: UNITADMB

NUMBER OF UNITS?

Field 2 Routing

Value

Label

Route

1

[Continuous answer.]

PM8 - DISCFLGB


Don't Know

PM8 - DISCFLGB


Refused

PM8 - DISCFLGB





Field 3: DISCFLGB

DISCONTINUED?

Field 3 Routing

Value

Label

Route

0

NO

PM9 - NOMORERX

1

YES

PM9 - NOMORERX





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

TIMESADM

MedicationData[x].TIMESADM = PM8 - TIMEADMB

DISCFLG

MedicationData[x].DISCFLG = PM8 - DISCFLGB

UNITSADM

If PM8 - TIMEADMB = 995, MedicationData[x].UNITSADM = PM8 - UNITADMB.



PM9 Yes/No



Question Text

Were any other prescribed medicines administered to (SP)?

Field 1: NOMORERX

Field 1 Routing

Value

Label

Route

0

NO

PMMTHFIN - MONTHFIN

1

YES

PM2 - PMNAMSEL


Don't Know

PMMTHFIN - MONTHFIN


Refused

PMMTHFIN - MONTHFIN





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PREFSTAT

If PM9-NOMORERX <> 1/Yes, then PREFSTAT = 1/DataCollected



Design Notes

Allow breakoff.
If breakoff occurs, set status of PM for this SP to BRK (Breakoff, 93).
The next time PM is selected for this SP, begin the application at PM1PRE and upon entering 1 and then pressing the END Key, program should take user to the screen where the breakoff occurred, in the same REF DATE in which the breakoff occurred.

PMMTHFIN Code 1



Question Text

YOU HAVE COMPLETED THE PRESCRIBED MEDICINE ENTRY FOR THIS MONTH.

PRESS "1" TO CONTINUE.

Field 1: MONTHFIN

Field 1 Routing

Value

Label

Route

1

CONTINUE

BOX PM10





BOX PM10



Box Instructions

IF THERE IS ANOTHER NON-COMPLETE PM REFERENCE MONTH, GO TO BOX PM1AA.

ELSE GO TO PM10 - DIDABPM.

Variable Name

Assignment Instructions

PMDISP

If there is another non-complete PM reference month, then PERS.PMDISP = 94/Missing Data



PM10 Code 1



Question Text

DID YOU ABSTRACT?

Field 1: DIDABPM

Field 1 Routing

Value

Label

Route

1

ALL

PM11 - WHYABPM

2

MAJORITY

PM11 - WHYABPM

3

HALF

PM11 - WHYABPM

4

SOME

PM11 - WHYABPM

5

NONE

PMENDSCR - PMEND





Other Programming Instructions

Background Variable Assignments

Variable Name

Assignment Instructions

PMDISP

PERS.PMDISP = 96/Complete



PM11 Code 1



Question Text

WHY DID YOU ABSTRACT?

Field 1: WHYABPM

Field 1 Routing

Value

Label

Route

1

NO KNOWLEDGEABLE RESPONDENT AVAILABLE

PMENDSCR - PMEND

2

NO TIME/STAFF BURDEN TOO GREAT

PMENDSCR - PMEND

3

REFUSAL--UNWILLING TO COOPERATE

PMENDSCR - PMEND

91

OTHER

PM11 - WHYABPOS





Field 2: WHYABPOS

OTHER (SPECIFY)

Field 2 Routing

Value

Label

Route

1

[Continuous answer.]

PMENDSCR - PMEND





PMENDSCR Code 1



Question Text

YOU HAVE COMPLETED THE PRESCRIBED MEDICINE SECTION FOR THIS SP.

PRESS "1" TO RETURN TO NAVIGATION SCREEN.

Field 1: PMEND

Field 1 Routing

Value

Label

Route

1

CONTINUE

BOX PMEND





BOX PMEND



Box Instructions

GO TO NAVIGATOR




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

© 2024 OMB.report | Privacy Policy