CMS-P-0015A Prescribed Medicine Utilization

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

PMQ - PRESCRIBED MEDICINE UTILIZATION

Question Type

Question Text/Description

Code List

Routing

PRESCRIBED MEDICINE UTILIZATION QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007, C010
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C004, C005, C006, C007) AND SEASON=WINTER, administer after ACQ.
If INTTYPE in(C001, C002, C004, C005, C006, C010) AND SEASON =SUMMER/FALL, administer after MPQ.

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

PMINTROA

no entry

PM1 - PMFILLED

[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

PM1

yes/no

[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?
[COUNT A MEDICINE AS "FILLED" 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.]

BOX PM1

PM1PMMEDS

GETPMMEDS

routing

no entry

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

(01) BOX PM1
(02) PM3 - PMREFILL
(-8) PM3 - PMREFILL
(-9) PM3 - PMREFILL

IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN ASKED IN THE CURRENT
ROUND, GO TO GETPMMEDS - 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.]

BOX PM2

[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.

BOX PM2

MEDICINE_PM1

routing

IF THERE IS AT LEAST ONE MEDICINE FROM A PRIOR ROUND ON THE EVENT TABLE FOR THIS
CASE, GO TO MEDICINE_PM1-MEDICINE_PM1.
ELSE GO TO PM2B-PMBOTTLE.

MEDICINE_PM1

code one

What is the name of the medicine?

BOX PM3

routing

IF THIS MEDICINE HAS AN EXACT MATCH TO THE FDB LIST ( PMEDID^=.), THEN GO TO PM2ASAMEFSAM.
ELSE GO TO PMBOTTLE-PMBOTTLE.

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

BOX PM3

Page 1 of 6

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

PMQ - PRESCRIBED MEDICINE UTILIZATION

Question Type

Question Text/Description

Code List

Routing

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

BOX PM4

CODE "YES" WITHOUT ASKING IF STATEMENT, RECEIPT, BOTTLE OR BAG IS PRESENT AND FORM,
STRENGTH AND AMOUNT ARE EXACTLY THE SAME AS IN THE PREVIOUS INTERVIEW.
At the time of the last interview, [you/(SP)] purchased (MEDICINE NAME) in the form of (MEDICINE FORM).
SAMEFSAM

SAMEFSAM

yes/no

The strength was [MEDICINE STRENGTH].
The amount in the container when it was obtained was (PREVIOUS ROUND MEDICINE AMOUNT).
Is this medicine in the same strength, form and amount?
CODE "NO" UNLESS FORM, STRENGTH, AND AMOUNT EXACTLY MATCH PREVIOUS ROUND.

BOX PM4

PMBOTTLE

PMBOTTLE

routing

IF SAMEFSAM=1/YES, THEN DO NOT CREATE A NEW EVENT FOR THIS MEDICINE AND GO TO PM6AGETNUM.
ELSE, CREATE A NEW EVENT FOR THIS MEDICINE AND GO TO PM2B-PMBOTTLE.

code one

(01) YES
CODE “YES” WITHOUT ASKING IF BOTTLE, CONTAINER, BAG, STATEMENT, OR RECEIPT IS PRESENT.
(02) NO
Do you have the medicine bottle, container or bag, or Prescription Drug Plan Statement available?
(03) NO BUT R CAN ANSWER QUESTIONS
IF R DOES NOT HAVE DOCUMENTATION, PROBE TO DETERMINE IF R CAN ANSWER QUESTIONS
(-8) DON'T KNOW
ABOUT THE FORM, STRENGTH, AND QUANTITY OF THE MEDICINE.
(-9) REFUSED

(01) MED-PMEDNAME
(02) PMKNWNM-PMKNWNM
(03) MED-PMEDNAME
(-8) PMKNWNM-PMKNWNM
(-9) PMKNWNM-PMKNWNM

TO USE THE MEDICINE LOOKUP, START TYPING THE MEDICINE NAME IN THE PRESCRIBED
MEDICINE LOOKUP BOX. CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.

PMEDNAME

MED

lookup

ONCE YOU HAVE ENTERED ALL DETAILS FOR A MEDICINE, IF YOU NEED TO GO BACK AND
CORRECT, USE THE GREEN “RETURN TO PRESCRIBED MEDICINE LOOKUP” BUTTON.

[MEDICINE NAME SELECTED FROM LOOKUP OR
MANUALLY TYPED]

[PRESCRIBED MEDICINE LOOKUP TOOL]

PMBRNAME

MED

lookup

[PM BRAND NAME]

PMGNNAME

MED

lookup

[PM GENERIC NAME]

PMFORMFD

MED

lookup

Medicine Form [FDB LIST FORM NAME]

PMFORMMC

MED

code one

Medicine Form [MCBS FORM]

PMFORMOS

MED

verbatim

PMFORMFN

MED

verbatim

[FINAL CONCATENATED MEDICINE FORM]

PMSTRNFD

MED

verbatim

Medicine Strength

[MEDICINE FORM OTHER SPECIFY]

(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
(-9) Refused

(01)-(12) MED-PMSTRNFD
(91) MED-PMFORMOS
(-8) MED-PMSTRNFD
(-9) MED-PMSTRNFD

(01) CONTINUOUS ANSWER

(01) [MEDICINE FORM SELECTED FROM LOOKUP]
(-7) NOT FOUND
(-8) DON'T KNOW

Page 2 of 6

2019 MCBS Community Questionnaire

PMQ - PRESCRIBED MEDICINE UTILIZATION

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

STRNNUMBB

MED

numeric

Medicine strength number

(01) CONTINUOUS ANSWER

STRNUNIT

MED

code one

PMSTRNOS

MED

verbatim

PMSTRUNI

MED

ookup

PMEDID

MED

numeric

FAMILYID

MED

numeric

PMKNWNM

PMKNWNM

code one

PMCOND

PMCOND

code one

PMCONDOS

PMCOND

verbatim

Medicine strength unit

TABNUM

GETNUM

numeric

BOX PM5

routing

TABNUM

numeric

(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
(-8) Don't Know
(-9) Refused

(01)-(08) MED-MEDID
(91) MED-PMSTRNOS
(-8) MED-PMEDID
(-9) MED-PMEDID

(01) YES
(02) NO
(-9) REFUSED

(01) MED-PMEDNAME
(02) PMCOND-PMCOND
(-9) PMCOND-PMCOND

(01) ALLERGY MEDICINE
(02) ALZHEIMERS
(03) ANTIBIOTICS
(04) ANTIPSYCHOTIC
(05) ASTHMA OR COPD
(06) BLOOD PRESSURE
(07) CHOLESTEROL
(08) COUGH AND COLD MEDICINE
(09) DEPRESSION
(10) DIABETES
(11) DIURETICS (WATER PILLS)
(12) EAR DROPS
(13) ESTROGEN
(14) EYE DROPS OR PREPARATION
(15) NASAL SPRAY/DROPS
(16) OSTEOPOROSIS (BONE LOSS)
(17) PAIN MEDICINE
(18) STEROID (GLUCOCORTICOID)
(19) STOMACH ACID OR ULCER
(20) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(01)-(19) GETNUM-GETNUM
(20) PMCOND-PMCONDOS
(-8) GETNUM-GETNUM
(-9) GETNUM-GETNUM

[MEDICINE STRENGTH UNIT OTHER SPECIFY]

[FINAL CONCATENATED MEDICINE STRENGTH]
[THIS VARIABLE STORES THE UNIQUE IDENTIFIER FOR PRESCRIBED MEDICINES ADDED THROUGH
THE LOOKUP. IT IS HIDDEN ON SCREEN.]
[THIS VARIABLE STORES THE UNIQUE IDENTIFIER FOR PRESCRIBED MEDICINES BY NAME ONLY,
EXCLUDING STRENGTH AND FORM, THROUGH THE LOOKUP. IT IS HIDDEN ON SCREEN.]
DOES THE RESPONDENT KNOW THE NAME OF THE MEDICINE?

What condition is this medicine prescribed for or what is its primary use?
IF THIS MEDICINE IS TAKEN FOR MORE THAN ONE CONDITION, SELECT ONLY ONE.

OTHER (SPECIFY)
How many times [since (REFERENCE DATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)] did [(you/(SP)] obtain (MEDICINE NAME)]]?

GETNUM

Routing

[IF THE MEDICINE WAS ENTERED IN ERROR AND WAS NOT OBTAINED IN THE CURRENT ROUND,
CHECK “ENTERED IN ERROR” AND LEAVE THE BOX BLANK WHERE YOU ENTER THE NUMBER OF
REFILLS.]
IF GETNUM=996/EVENT ENTERED IN ERROR OR PMKNWNM=02/NO OR SAMEFSAM=1/YES, GO TO
PMMORE-PMMORE;
ELSE IF MEDICINE FORM IS PILLS, TABLETS OR CAPSULES [PMFORMMC=1 OR PMFORMFD
CONTAINS ("PILL", "TAB", "CAP") GO TO TABNUM-TABNUM;
ELSE GO TO PM16-AMTUNIT.
HOW MANY PILLS, TABLETS, OR CAPSULES WERE IN THE CONTAINER WHEN IT WAS OBTAINED?

(01) CONTINUOUS ANSWER
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(996) EVENT ENTERED IN ERROR
(-8) Don't Know
(-9) Refused

BOX PM5

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

BOX PM6

Page 3 of 6

2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

PMQ - PRESCRIBED MEDICINE UTILIZATION

Question Type

Question Text/Description

Code List

Routing
(01) PM16 - AMTNUM
(02) PM16 - AMTNUM
(03) PM16 - AMTNUM
(04) PM16 - AMTNUM
(05) PM16 - AMTNUM
(06) PM16 - AMTNUM
(07) PM16 - AMTNUM
(91) PM16 - AMTUNOS
(-8) BOX PM6

AMTUNIT

PM16

quantity unit

HOW MUCH MEDICINE WAS IN THE CONTAINER WHEN IT WAS OBTAINED?
[PLEASE ENTER THE AMOUNT IN THE CONTAINER, NOT THE STRENGTH OF THE MEDICINE.]

(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

AMTUNOS

PM16

text

OTHER (SPECIFY)

(01) CONTINUOUS ANSWER

PM16 - AMTNUM

AMTNUM

PM16

numeric

(01) CONTINUOUS ANSWER

BOX PM6

BOX PM6

routing

IF PRESCRIPTION MEDICINE FORM IS PILLS, TABLETS OR CAPSULES, GO TO PM12 - TABSADAY.
ELSE GO TO BOX PM7.
HOW MANY PILLS, TABLETS, OR CAPSULES ARE PRESCRIBED TO BE TAKEN IN A DAY?

TABSADAY

PM12

numeric

TABSADAY95

PM12

code one

IF LESS THAN ONE UNIT IS TO BE TAKEN PER DAY, ENTER THE APPROPRIATE DECIMAL VALUE (EX:
HALF A PILL SHOULD BE ENTERED AS "0.5")
FOR MEDICINES TO BE TAKEN “AS NEEDED,” ENTER THE MAXIMUM AMOUNT THAT IS TO BE TAKEN (01) CONTINUOUS ANSWER
IN A DAY AND SELECT "TAKE AS NEEDED".
FOR MEDICINES TO BE TAKEN ON AN IRREGULAR SCHEDULE OR THAT VARY BY DAY, SELECT
"OTHER DOSING INSTRUCTIONS".
IF THE AMOUNT TO BE TAKEN PER DAY IS NOT CLEAR OR NOT INDICATED, SELECT "DON'T KNOW".

(02) TAKE AS NEEDED
(03) OTHER DOSING INSTRUCTIONS
(-7) Empty

PM12 - TABSADAY95

PM13-TABTAKE

How many pills, tablets, or capsules (do/did/does) [you/(SP)] usually take in a day?
[READ IF NECESSARY: This question is asking about how often you actually take the medicine, not how often
the medicine is prescribed to be taken.]

TABTAKE

TABTAKE96

PMSATVA

PMSATHMO

PM13

numeric

PM13

code one

BOX PM7

routing

PMSATVA

yes/no

BOX PM8

routing

PMSATHMO

yes/no

(01) CONTINUOUS ANSWER
(-7) EMPTY
IF LESS THAN ONE UNIT IS TAKEN PER DAY, ENTER THE APPROPRIATE DECIMAL VALUE (EX: HALF A
(-8) DON'T KNOW
PILL SHOULD BE ENTERED AS "0.5")
FOR MEDICINES TAKEN “AS NEEDED,” SELECT "TAKE AS NEEDED".
FOR MEDICINES TAKEN ON AN IRREGULAR SCHEDULE OR THAT VARY BY DAY, SELECT "OTHER
DOSING INSTRUCTIONS".

(01) DON'T TAKE EVERY DAY
(02) TAKE AS NEEDED
(03) OTHER DOSING INSTRUCTIONS
(-7) EMPTY

PM13 - TABTAKE96

BOX PM7

IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A. IN THE CURRENT ROUND OR
ANY PREVIOUS ROUND), GO TO PMSATVA - PMSATVA.
ELSE GO TO BOX PM8.

(01) YES
Did [you/(SP)] obtain (this purchase/any of these purchases) of (MEDICINE NAME) through the Department of (02) NO
(-8) DON'T KNOW
Veterans Affairs or V.A.?
(-9) REFUSED
IF SP COVERED BY A MEDICARE MANAGED CARE PLAN OR A PRIVATE MANAGED CARE PLAN
ANYTIME DURING THE CURRENT ROUND, GO TO PMSATHMO - PMSATHMO.
ELSE GO TO PMMORE-PMMORE.
Did [you/(SP)] obtain (this purchase/any of these purchases) of (MEDICINE NAME) at [READ MANAGED
CARE PLAN NAME(S) BELOW] or through a service or discount offered through [READ MANAGED CARE
PLAN NAME(S) BELOW]?
[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.]

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

BOX PM8

PMMORE-PMMORE

Page 4 of 6

2019 MCBS Community Questionnaire

Variable Name

PMMORE

PMREFILL

PMDRPHON

MR Screen Name

PM17

PMREFILL

PMQ - PRESCRIBED MEDICINE UTILIZATION

Question Type

yes/no

yes/no

Question Text/Description
([NO MEDICINES HAVE BEEN REPORTED FOR (SP) FOR THE CURRENT REFERENCE PERIOD/THE
NAMES OF ALL MEDICINES REPORTED FOR THE CURRENT REFERENCE PERIOD ARE DISPLAYED
BELOW.])
[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?]
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.]

Code List

Routing

(01) ADD ANOTHER
(02) ALL DONE

(01) BOX PM2
(02) PMREFILL - PMREFILL

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

(01) BOX PM2
(02) PMDRPHON - PMDRPHON
(-8) PMDRPHON - PMDRPHON
(-9) PMDRPHON - PMDRPHON

PMDRPHON

yes/no

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
(01) YES
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)]?
(02) NO
(-8) DON'T KNOW
[INLCUDE ALL PRESCRIBED MEDICINES REGARDLESS OF WHO OBTAINED IT FOR THE
(-9) REFUSED
RESPONDENT, WHEN IT WAS OBTAINED, WHETHER OR NOT THE PRESCRIPTION COST ANYTHING,
AND WHETHER OR NOT THE RESPONDENT ACTUALLY TOOK THE MEDICINE.]

BOX PM4

routing

IF SPALIVE=1 (ALIVE) AND SEASON=FALL GO TO PMNOTGET-PMNOTGET. ELSE GO TO BOX PMEND.

(01) BOX PM2
(02) BOX PM4
(-8) BOX PM4
(-9) BOX PM4

PMNOTGET

PMNOTGET

yes/no

(01) YES
During (CURRENT YEAR) were any medicines prescribed for [you/(SP)] that [you/he/she] did not get? Please
(02) NO
include refills of earlier prescriptions as well as prescriptions that were written or phoned in by a doctor or other
(-8) Don't Know
health professional.
(-9) Refused

TEMPMED1

SC16

text

What were the names of those medicines?
ENTER ALL MEDICINES.

(01) [Continuous answer.]

SC16 - TEMPMED2

TEMPMED2

SC16

text

What were the names of those medicines?
ENTER ALL MEDICINES.

(01) [Continuous answer.]
(-7) Empty

(01) SC16 - TEMPMED3
(-7) SCPMCODS -SCPMCODS

TEMPMED3

SC16

text

What were the names of those medicines?
ENTER ALL MEDICINES.

(01) [Continuous answer.]
(-7) Empty

(01) SC16 - TEMPMED4
(-7) SCPMCODS -SCPMCODS

TEMPMED4

SC16

text

What were the names of those medicines?
ENTER ALL MEDICINES.

(01) [Continuous answer.]
(-7) Empty

(01) SC16 - TEMPMED5
(-7)SCPMCODS -SCPMCODS

TEMPMED5

SC16

text

What were the names of those medicines?
ENTER ALL MEDICINES.

(01) [Continuous answer.]
(-7) Empty

SCPMCODS -SCPMCODS

(01) THOUGHT IT WOULD COST TOO MUCH
(02) DIDN'T THINK MEDICINE WOULD HELP
CONDITION
(03) WAS AFRAID OF MEDICINE
REACTIONS/CONTRAINDICATIONS
(04) DON'T LIKE TO TAKE MEDICINE
(05) DIDN'T THINK MEDICINE WAS NECESSARY
(06) NOT COVERED BY INSURANCE/NOT ON PLAN
FORMULARY
(07) TROUBLE OBTAINING MEDICINE
(08) OBTAINED/USED SAMPLES
(09) USED ANOTHER MEDICINE AS A
SUBSTITUTION
(91) (OTHER/SC17A - SCPMOTOS OTHER SPECIFY
TEXT)
(-8) Don't Know
(-9) Refused

(01) BOX SC2
(02) BOX SC2
(03) BOX SC2
(04) BOX SC2
(05) BOX SC2
(06) BOX SC2
(07) BOX SC2
(08) BOX SC2
(09) BOX SC2
(91) SCPMOTOS - SCPMOTOS
(-8) BOX PMEND
(-9) BOX PMEND

SHOW CARD PM1
This card lists some reasons people have given for not having prescriptions filled or refilled.
Which of these reasons explains why [you/(SP)] did not obtain the [READ MEDICINE(S) BELOW]?
SCPMCODS

SCPMCODS

code all

[MEDICINE 1 FROM SC16]
[MEDICINE 2 FROM SC16]
[MEDICINE 3 FROM SC16]
[MEDICINE 4 FROM SC16]
[MEDICINE 5 FROM SC16]
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

(01) SC16 - TEMPMED1
(02) BOX PMEND
(-8) BOX PMEND
(-9) BOX PMEND

Page 5 of 6

2019 MCBS Community Questionnaire

PMQ - PRESCRIBED MEDICINE UTILIZATION

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

SCPMOTOS

SCPMOTOS

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer.]

BOX SC2

BOX SC2

routing

IF SCPMCODS - SCPMCODS INCLUDES MORE THAN ONE RESPONSE, GO TO SCPMMAIN SCPMMAIN.
ELSE GO TO BOX PMEND.

Which of these was the main reason [you/(SP)] did not obtain [this medicine/these medicines] during
(CURRENT YEAR)?
[READ REASONS BELOW IF NECESSARY.]
SCPMMAIN

SCPMMAIN

code 1

[MEDICINE 1 FROM SC16]
[MEDICINE 2 FROM SC16]
[MEDICINE 3 FROM SC16]
[MEDICINE 4 FROM SC16]
[MEDICINE 5 FROM SC16]

BOX PMEND

routing

GO TO OMQ.

(01) THOUGHT IT WOULD COST TOO MUCH
(02) DIDN'T THINK MEDICINE WOULD HELP
CONDITION
(03) WAS AFRAID OF MEDICINE
REACTIONS/CONTRAINDICATIONS
(04) DON'T LIKE TO TAKE MEDICINE
(05) DIDN'T THINK MEDICINE WAS NECESSARY
(06) NOT COVERED BY INSURANCE/NOT ON PLAN
BOX PMEND
FORMULARY
(07) TROUBLE OBTAINING MEDICINE
(08) OBTAINED/USED SAMPLES
(09) USED ANOTHER MEDICINE AS A
SUBSTITUTION
(91) (OTHER/SC17A - SCPMOTOS OTHER SPECIFY
TEXT)
(-8) Don't Know
(-9) Refused

Page 6 of 6