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pdfVariable Name
MR Screen Name
Question type
Question text/description
Code list
Routing
ACQ SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after MPQ.
NOTES: As part of Content Management Cycle 1, it was decided that ACQ would move from the Fall round to
the Winter round. Therefore, ACQ was removed from R79 and will be fielded in R80.
ACINT
ERVISIT
EWAITUNT
EWAITHRS
EWAITMIN
BOX AC1AA
routing
IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT HAVE ER VISIT IN
CURRENT ROUND AND AC6A NOT ALREADY ASKED), GO TO ACINTRO - ACINT.
ELSE IF (SP HAD AN ER VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND (AC6A NOT
ALREADY ASKED), GO TO AC6A - EWAITUNT.
ELSE GO TO BOX AC1C.
ACINTRO
no entry
The next questions are about health care services [you/(SP)] may have used since (REFERENCE DATE).
AC1
AC6A
AC6A
AC6A
BOX AC1C
OPDVISIT
AC8
AC1 - ERVISIT
Since (REFERENCE DATE), did [you/(SP)] go to a hospital emergency room?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC6A - EWAITUNT
(02) AC8 - OPDVISIT
(-8) AC8 - OPDVISIT
(-9) AC8 - OPDVISIT
code one
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)]
have to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person?
Please include the time spent in the waiting room and exam room.
(00) DID NOT HAVE TO WAIT
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) Don't Know
(-9) Refused
(00) BOX AC1C.
(01) AC6A - EWAITHRS
(02) AC6A - EWAITMIN
(03) AC6A - EWAITHRS
(-8) BOX AC1C
(-9) BOX AC1C
numeric
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)]
have to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person?
Please include the time spent in the waiting room and exam room.
(01) continuous answer
If AC6A - EWAITUNT =
3/HoursAndMinutes, go to AC6A EWAITMIN.
Else go to BOX AC1C.
numeric
Think about the most recent time [you/(SP)] went to the hospital emergency room. How long did [you/(SP)]
have to wait during (your/his/her) visit before (you/he/she) saw a doctor or some other medical person?
Please include the time spent in the waiting room and exam room.
(01) continuous answer
BOX AC1C
routing
IF AC6A ASKED WHILE ADMINISTERING ER, GO TO BOX ER6.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT HAVE OP VISIT
IN CURRENT ROUND AND AC16A NOT ALREADY ASKED), GO TO AC8 - OPDVISIT.
ELSE IF (SP HAD AN OP VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND (AC9AC16A NOT ALREADY ASKED), GO TO AC9 - OPDREAS.
ELSE GO TO BOX AC1E.
yes/no
Since (REFERENCE DATE), did [you/(SP)] go to a hospital clinic or outpatient department?
DO NOT INCLUDE HOSPITAL INPATIENT STAYS.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC9 - OPDREAS
(02) BOX AC1E
(-8) BOX AC1E
(-9) BOX AC1E
yes/no
Variable Name
MR Screen Name
Question type
Question text/description
Code list
[I have a few more questions about visits that [you/(SP)] had in the past.]
OPDREAS
AC9
code all
(01) MEDICAL CONDITION NAMED
(02) TESTS
Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department. What was
(03) FOLLOW-UP
the reason [you/(SP)] went to the hospital clinic or outpatient department?
(04) CHECKUP
[PROBE FOR THE MOST RECENT VISIT IF RESPONDENT MENTIONS MORE THAN ONE. IF NEEDED, PROBE WITH (05) REFERRAL
(06) SURGERY
‘What did you have done during your most recent visit to the hospital clinic or outpatient department?’
(07) PREVENTIVE SHOT
SELECT ALL THAT APPLY.]
(08) TREATMENT SHOT
[PROBE: Any other reason?]
(09) TO GET OR REFILL PRESCRIPTION
(91) OTHER
THE MOST RECENT VISIT CAN BE OUTSIDE OF THE REFERENCE PERIOD USED IN OTHER SECTIONS
(-8) Don't Know
(-9) Refused
CHECK ALL THAT APPLY.
OPDOTHOS
AC9
verbatim text
OTHER (SPECIFY)
routing
IF (INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND SP DID NOT REPORT
OUTPATIENT DEPARTMENT VISIT AT OP4) AND (RESPONSE TO AC9 - OPDREAS INCLUDES 1/MedCondNamed
OR 6/Surgery), GO TO AC12 - OPDAPPT.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND SP DID NOT REPORT
OUTPATIENT DEPARTMENT VISIT AT OP4) AND (RESPONSE TO AC9 - OPDREAS DOES NOT INCLUDE
1/MedCondNamed AND DOES NOT INCLUDE 6/Surgery), GO TO AC10 - OPDSCOND.
ELSE GO TO AC12 - OPDAPPT.
BOX AC1D
OPDSCOND
OPDAPPT
OPDDRTEL
AC10
AC12
AC13
yes/no
code one
code one
(01) continuous answer
(01) YES
(02) NO
Was that for a specific condition?
(-8) Don't Know
(-9) Refused
(01) APPOINTMENT
Did [you/(SP)] have an appointment for this visit to the hospital clinic or outpatient department, or did
(02) WALKED IN
(you/he/she) just walk in?
(-8) Don't Know
(-9) Refused
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
We are interested in knowing how the appointment was made for the visit to the hospital clinic or outpatient
(02) SP CONTACTED OFFICE TO SET UP
department you just told me about.
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the hospital clinic or
UP APPOINTMENT
outpatient department to set up the appointment ?
(-8) Don't Know
(-9) Refused
(00) DID NOT HAVE TO WAIT
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) DAYS
(02) WEEKS
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE APPOINTMENT (03) MONTHS
(-8) Don't Know
AND THE ACTUAL DATE OF THE APPOINTMENT
(-9) Refused
Routing
(01) BOX AC1D
(02) BOX AC1D
(03) BOX AC1D
(04) BOX AC1D
(05) BOX AC1D
(06) BOX AC1D
(07) BOX AC1D
(08) BOX AC1D
(09) BOX AC1D
(91) AC9 - OPDOTHOS
(-8) BOX AC1D
(-9) BOX AC1D
BOX AC1D
AC12 - OPDAPPT
(01) AC13 - OPDDRTEL
(02) AC16A - OWAITUNT
(-8) AC16A - OWAITUNT
(-9) AC16A - OWAITUNT
(01) AC14 - OPDAWUNT
(02) AC14 - OPDAWUNT
(03) AC14 - OPDAWUNT
(-8) AC16A - OWAITUNT
(-9) AC16A - OWAITUNT
(00) AC16A - OWAITUNT
(01) AC14 - OPDAWDAY
(02) AC14 - OPDAWWKS
(03) AC14 - OPDAWMOS
(-8) AC16A - OWAITUNT
(-9) AC16A - OWAITUNT
OPDAWUNT
AC14
code one
OPDAWDAY
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - OWAITUNT
OPDAWWKS
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - OWAITUNT
OPDAWMOS
AC14
numeric
How long did [you/(SP)] have to wait for the appointment -- about how many days, weeks, or months?
(01) continuous answer
AC16A - OWAITUNT
code one
(00) DID NOT HAVE TO WAIT
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
(01) HOURS ONLY
(02) MINUTES ONLY
How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a doctor (03) HOURS AND MINUTES
(-8) Don't Know
or some other medical person? Please include the time spent in the waiting room and exam room.
(-9) Refused
OWAITUNT
AC16A
(00) BOX AC1E
(01) AC16A - OWAITHRS
(02) AC16A - OWAITMIN
(03) AC16A - OWAITHRS
(-8) BOX AC1E
(-9) BOX AC1E
Variable Name
MR Screen Name
Question type
Question text/description
Code list
Routing
(01) continuous answer
If AC16A - OWAITUNT =
3/HoursAndMinutes, go to AC16A OWAITMIN.
Else go to BOX AC1E.
(01) continuous answer
BOX AC1E
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) AC20 - MDSPCLTY
(02) BOX AC1G
(-8) BOX AC1G
(-9) BOX AC1G
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
OWAITHRS
AC16A
numeric
How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a doctor
or some other medical person? Please include the time spent in the waiting room and exam room.
[Think about the most recent time [you/(SP)] went to a hospital clinic or outpatient department.]
OWAITMIN
AC16A
BOX AC1E
MDVISIT
AC19
numeric
How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she) saw a doctor
or some other medical person? Please include the time spent in the waiting room and exam room.
routing
IF AC9-AC16A ASKED WHILE ADMINISTERING OP, GO TO BOX OP7.
ELSE IF INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT REPORT A
MEDICAL PROVIDER VISIT AT MP6 WHERE (MP6B - MPSDVIS ^= 1/Yes AND PROVIDER'S SPECIALTY IS A
MEDICAL DOCTOR) AND (AC20-AC28A1 NOT ALREADY ASKED)), GO TO AC19-MDVISIT.
ELSE IF (SP HAD AN MP VISIT IN THE CURRENT ROUND OR ANY OF THE 2 PREVIOUS ROUNDS) AND (AC20AC28A1 NOT ALREADY ASKED), GO TO AC20 - MDSPCLTY.
ELSE GO TO BOX AC1G.
yes/no
Next, I want to ask about [your/(SP)’s] visits to doctors since (REFERENCE DATE). [Have you/Has (SP)] seen a
medical doctor since (REFERENCE DATE)? Please do not include a doctor seen at home, at an emergency
room or outpatient department, or while an inpatient at a hospital.
[IF NECESSARY, SAY, ‘Please look at show card AC1 for examples of types of medical doctors.’]
Variable Name
MR Screen Name
Question type
Question text/description
Code list
MDSPCLTY
AC20
code one
(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(07) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(08) FAMILY PRACTICE
(09) GASTROENTEROLOGY
(10) GENERAL PRACTICE
(11) GENERAL SURGERY
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
(14) HEMATOLOGY (BLOOD)
(15) HOSPITAL RESIDENCE
(16) INTERNAL MEDICINE (INTERNIST)
(17) NEPHROLOGY (KIDNEYS)
SHOW CARD AC1
(18) NEUROLOGY
(19) NUCLEAR MEDICINE
[I have a few more questions about visits that [you/(SP)] had in the past.]
(20) ONCOLOGY (TUMORS, CANCER)
(21) OPHTHALMOLOGY (EYES)
Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
(22) ORTHOPEDICS
hospital. What was the doctor’s specialty?
(24) OSTEOPATHY (DO)
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC' SPECIALITY (25) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE GENERIC WORD IS
SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE RESPONSE CATEGORY FOR THAT (36) PAIN MANAGEMENT SPECIALIST
(26) PATHOLOGY
SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR SPECIALTY'.]
(27) PHYS MED/REHAB
(37) PHYSICIAN’S ASSISTANT
(28) PLASTIC SURGERY
(38) PODIATRIST
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(39) VASCULAR SURGEON/SPECIALIST
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
MDSPCLOS
AC20
verbatim text
OTHER DR SPECIALTY (SPECIFY)
MDREAS
AC21
code all
MDREAS
AC21
verbatim text
(01) continuous answer
(01) MEDICAL CONDITION NAMED
(02) TESTS
(03) FOLLOW-UP
(04) CHECKUP
What was the reason [you/(SP)] saw the doctor?
(05) REFERRAL
(06) SURGERY
[PROBE: ‘What did you have done during the visit?’ IF RESPONDENT DOES NOT UNDERSTAND WHAT IS BEING
(07) PREVENTIVE SHOT
ASKED. PROBE: ‘Any other reason?’ TO OBTAIN ALL REASONS.]
(08) TREATMENT SHOT
CHECK ALL THAT APPLY.
(09) TO GET OR REFILL PRESCRIPTION
(91) OTHER
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
(01) continuous answer
Routing
(01) AC21 - MDREAS
(02) AC21 - MDREAS
(03) AC21 - MDREAS
(05) AC21 - MDREAS
(07) AC21 - MDREAS
(08) AC21 - MDREAS
(09) AC21 - MDREAS
(10) AC21 - MDREAS
(11) AC21 - MDREAS
(12) AC21 - MDREAS
(13) AC21 - MDREAS
(14) AC21 - MDREAS
(15) AC21 - MDREAS
(16) AC21 - MDREAS
(17) AC21 - MDREAS
(18) AC21 - MDREAS
(19) AC21 - MDREAS
(20) AC21 - MDREAS
(21) AC21 - MDREAS
(22) AC21 - MDREAS
(24) AC21 - MDREAS
(25) AC21 - MDREAS
(36) AC21 - MDREAS
(26) AC21 - MDREAS
(27) AC21 - MDREAS
(37) AC21 - MDREAS
(28) AC21 - MDREAS
(38) AC21 - MDREAS
(29) AC21 - MDREAS
(30) AC21 - MDREAS
(31) AC21 - MDREAS
(32) AC21 - MDREAS
(33) AC21 - MDREAS
(34) AC21 - MDREAS
(35) AC21 - MDREAS
(39) AC21 - MDREAS
(91) AC20 - MDSPCLOS
(-8) AC21 - MDREAS
(-9) AC21 - MDREAS
AC21 - MDREAS
(01) BOX AC1F
(02) BOX AC1F
(03) BOX AC1F
(04) BOX AC1F
(05) BOX AC1F
(06) BOX AC1F
(07) BOX AC1F
(08) BOX AC1F
(09) BOX AC1F
(91) AC21 - MDOTHOS
(-8) BOX AC1F
(-9) BOX AC1F
BOX AC1F
Variable Name
MDSCOND
MDAPPT
MDDRTEL
MR Screen Name
Question type
BOX AC1F
routing
AC22
yes/no
AC24
AC25
code one
code one
MDAWUNT
AC26
code one
MDAWDAY
AC26
numeric
MDAWWKS
AC26
numeric
MDAWMOS
AC26
numeric
MWAITUNT
AC28A1
code one
MWAITHRS
AC28A1
numeric
MWAITMIN
AC28A1
numeric
BOX AC1G
routing
Question text/description
Code list
IF (INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT REPORT A
MEDICAL PROVIDER VISIT AT MP6 WHERE (MP6B - MPSDVIS ^= 1/Yes AND PROVIDER'S SPECIALTY IS A
MEDICAL DOCTOR))) AND (RESPONSE TO AC21- MDREAS INCLUDES 1/MedCondNamed OR 6/Surgery), GO TO
AC24 - MDAPPT.
ELSE IF (INTTYPE=7 AND VIEW_MCBSCOMM_PRELOAD.NEWLY_ELIGIBLE NE 1 AND (SP DID NOT REPORT A
MEDICAL PROVIDER VISIT AT MP6 WHERE (MP6B - MPSDVIS ^= 1/Yes AND PROVIDER'S SPECIALTY IS A
MEDICAL DOCTOR))) AND (RESPONSE TO AC21- MDREAS DOES NOT INCLUDE 1/MedCondNamed AND DOES
NOT INCLUDE 6/Surgery), GO TO AC22 - MDSCOND.
ELSE GO TO AC24 - MDAPPT.
(01) YES
(02) NO
Was that for a specific condition?
(-8) Don't Know
(-9) Refused
(01) APPOINTMENT
(02) WALKED IN
Did [you/(SP)] have an appointment for this visit with the doctor, or did (you/he/she) just walk in?
(-8) Don't Know
(-9) Refused
(01) SOMEONE MADE APPOINTMENT DURING
EARLIER VISIT
We are interested in knowing how the appointment was made for the visit to the doctor’s office you just told (02) SP CONTACTED OFFICE TO SET UP
me about.
APPOINTMENT
(03) DOCTOR'S OFFICE CONTACTED SP TO SET
Did someone make this appointment during an earlier visit, or did [you/(SP)] contact the doctor’s office to set UP APPOINTMENT
(04) STANDING APPOINTMENT
up the appointment?
(-8) Don't Know
(-9) Refused
(00) DID NOT HAVE TO WAIT
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
(01) DAYS
weeks, or months?
(02) WEEKS
(03) MONTHS
WE ARE ASKING HOW MUCH TIME PASSED BETWEEN THE FIRST CONTACT FOR SETTING THE APPOINTMENT
(-8) Don't Know
AND THE ACTUAL DATE OF THE APPOINTMENT
(-9) Refused
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
(01) continuous answer
weeks, or months?
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
(01) continuous answer
weeks, or months?
How long did [you/(SP)] have to wait for the appointment with the medical doctor -- about how many days,
(01) continuous answer
weeks, or months?
(00) DID NOT HAVE TO WAIT
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
(01) HOURS ONLY
hospital.] How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she)
(02) MINUTES ONLY
saw a doctor or some other medical person? Please include the time spent in the waiting room and exam
(03) HOURS AND MINUTES
(-8) Don't Know
room.
(-9) Refused
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she)
(01) continuous answer
saw a doctor or some other medical person? Please include the time spent in the waiting room and exam
room.
[Think about the most recent time [you/(SP)] saw a medical doctor somewhere other than at home or at a
hospital.] How long did [you/(SP)] have to wait during (your/his/her) most recent visit before (you/he/she)
(01) continuous answer
saw a doctor or some other medical person? Please include the time spent in the waiting room and exam
room.
IF AC20-AC28A1 ASKED WHILE ADMINISTERING MP, GO TO MP18 - MPPRPRAC.
ELSE IF SP HAS A CURRENT MEDICARE MANAGED CARE PLAN, GO TO AC33 - MHREFDIF.
ELSE GO TO BOX AC3.
Routing
AC24 - MDAPPT
(01) AC25 - MDDRTEL
(02) AC28A1 - MWAITUNT
(-8) AC28A1 - MWAITUNT
(-9) AC28A1 - MWAITUNT
(01) AC26 - MDAWUNT
(02) AC26 - MDAWUNT
(03) AC26 - MDAWUNT
(04) AC28A1 - MWAITUNT
(-8) AC28A1 - MWAITUNT
(-9) AC28A1 - MWAITUNT
(00) AC28A1 - MWAITUNT
(01) AC26 - MDAWDAY
(02) AC26 - MDAWWKS
(03) AC26 - MDAWMOS
(-8) AC28A1 - MWAITUNT
(-9) AC28A1 - MWAITUNT
AC28A1 - MWAITUNT
AC28A1 - MWAITUNT
AC28A1 - MWAITUNT
(00) BOX AC1G
(01) AC28A1 - MWAITHRS
(02) AC28A1 - MWAITMIN
(03) AC28A1 - MWAITHRS
(-8) BOX AC1G
(-9) BOX AC1G
If AC28A1 - MWAITUNT =
3/HoursAndMinutes, go to AC28A1 MWAITMIN.
Else go to BOX AC1G.
BOX AC1G
Variable Name
MHREFDIF
MR Screen Name
AC33
Question type
code one
MHSPCLTY
AC34A
code one
MHSPCLOS
AC34A
verbatim text
Question text/description
The following questions are about health care that [you/(SP)] received through (CURRENT MEDICARE
MANAGED CARE PLAN NAME).
Code list
(01) YES
(02) NO
While a member of (CURRENT MEDICARE MANAGED CARE PLAN NAME), [have you/has (SP)] had difficulty in
(03) N/A, HAVEN'T TRIED TO OBTAIN
obtaining referrals for the services of a specialist or other medical person within (CURRENT MEDICARE
REFERRAL
MANAGED CARE PLAN NAME) that [you/(SP)] thought were necessary?
(-8) Don't Know
[IF NECESSARY, SAY: ‘The referral must have been for services provided by a specialist or medical provider
(-9) Refused
who is associated with your Medicare Managed Care plan, not a specialist or medical provider who is
"outside" of the plan.’]
(01) ALLERGY/IMMUNOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(07) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(09) GASTROENTEROLOGY
(11) GENERAL SURGERY
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
(14) HEMATOLOGY (BLOOD)
(16) INTERNAL MEDICINE (INTERNIST)
SHOW CARD AC2
(17) NEPHROLOGY (KIDNEYS)
What kind of specialist or medical person was this?
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC' SPECIALITY (18) NEUROLOGY
(20) ONCOLOGY (TUMORS, CANCER)
LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE GENERIC WORD IS
SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE RESPONSE CATEGORY FOR THAT (21) OPHTHALMOLOGY (EYES)
(22) ORTHOPEDICS
SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR SPECIALTY'.]
(24) OSTEOPATHY (DO)
(25) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
(26) PATHOLOGY
(27) PHYS MED/REHAB
(28) PLASTIC SURGERY
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(33) RHEUMATOLOGY (ARTHRITIS)
(35) UROLOGY
(36) AUDIOLOGIST
(37) CHIROPRACTOR
(38) DENTIST
(39) OPTOMETRIST
(40) PHYSICAL THERAPIST
(41) PSYCHOLOGIST
(91) OTHER DR SPECIALTY
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
(01) continuous answer
Routing
(01) AC34A - MHSPCLTY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
(01) AC35 - MHDIFCLT
(03) AC35 - MHDIFCLT
(05) AC35 - MHDIFCLT
(07) AC35 - MHDIFCLT
(09) AC35 - MHDIFCLT
(11) AC35 - MHDIFCLT
(12) AC35 - MHDIFCLT
(13) AC35 - MHDIFCLT
(14) AC35 - MHDIFCLT
(16) AC35 - MHDIFCLT
(17) AC35 - MHDIFCLT
(18) AC35 - MHDIFCLT
(20) AC35 - MHDIFCLT
(21) AC35 - MHDIFCLT
(22) AC35 - MHDIFCLT
(24) AC35 - MHDIFCLT
(25) AC35 - MHDIFCLT
(26) AC35 - MHDIFCLT
(27) AC35 - MHDIFCLT
(28) AC35 - MHDIFCLT
(29) AC35 - MHDIFCLT
(30) AC35 - MHDIFCLT
(31) AC35 - MHDIFCLT
(33) AC35 - MHDIFCLT
(35) AC35 - MHDIFCLT
(36) AC35 - MHDIFCLT
(37) AC35 - MHDIFCLT
(38) AC35 - MHDIFCLT
(39) AC35 - MHDIFCLT
(40) AC35 - MHDIFCLT
(41) AC35 - MHDIFCLT
(91) AC34A - MHSPCLOS
(-8) AC35 - MHDIFCLT
(-9) AC35 - MHDIFCLT
AC35 - MHDIFCLT
Variable Name
MR Screen Name
Question type
Question text/description
What kind of difficulty did [you/(SP)] have?
MHDIFCLT
AC35
code all
MHOTHOS
AC35
verbatim text
OTHER (SPECIFY)
AC36
code one
Has (CURRENT MEDICARE MANAGED CARE PLAN NAME) ever refused to pay for emergency treatment that
[you/(SP)] felt was necessary?
[‘EMERGENCY TREATMENT’ REFERS TO URGENTLY NEEDED MEDICAL CARE THAT IS REQUIRED WHEN THE
BENEFICIARY IS OUTSIDE OF THE PLAN'S SERVICE AREA OR WHEN THE CARE IS REQUIRED DURING A TIME
THAT IS OUTSIDE THE PLAN'S NORMAL OPERATING HOURS.]
BOX AC3
routing
IF 11TH ROUND INTERVIEW AND (INTTYPE IN C001) AND (MREFDATE) IS AFTER (JANUARY 1 (CURRENT YEAR))
GO TO STQ.
ELSE GO TO PMQ.
MHREFPAY
[PROBE: Any other difficulty?]
CHECK ALL THAT APPLY.
Code list
Routing
(01) PLAN WOULDN’T AUTHORIZE SERVICE
(02) THE WAIT FOR APPOINTMENT WAS TOO
LONG
(03) PROVIDER’S LOCATION WAS NOT
CONVENIENT
(04) DOCTOR/PLAN WOULDN'T GIVE SP
REFERRAL TO SEE PROVIDER SP WANTED TO
SEE
(05) SP DIDN'T LIKE/NOT CONFIDENT IN
PROVIDER PLAN REFERRED SP TO
(06) PROVIDER’S OFFICE HOURS WERE NOT
CONVENIENT
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) AC36 - MHREFPAY
(02) AC36 - MHREFPAY
(03) AC36 - MHREFPAY
(04) AC36 - MHREFPAY
(05) AC36 - MHREFPAY
(06) AC36 - MHREFPAY
(91) AC35 - MHOTHOS
(-8) AC36 - MHREFPAY
(-9) AC36 - MHREFPAY
(01) continuous answer
(01) YES
(02) NO
(03) N/A, HAVEN'T NEEDED EMERGENCY
TREATMENT
(-8) Don't Know
(-9) Refused
AC36 - MHREFPAY
BOX AC3
| File Type | application/pdf |
| Author | SLA |
| File Modified | 2018-05-01 |
| File Created | 2018-05-01 |