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pdf2020 MCBS Community Questionnaire
Variable Name
MR Screen Name
HFQ - HEALTH STATUS AND FUNCTIONING
Question type
Question text/description
Code list
Routing
HEALTH STATUS AND FUNCTIONING QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C003, C004, C005, C006), administer after PVQ.
GENHELTH
BOX HFBEG
routing
GO TO HFA1 - GENHELTH
HFA1
code one
In general, compared to other people [your/(SP's)] age, would you say that [your/his/her] health is . . .
SHOW CARD HF1
COMPHLTH
HFA2
code one
Compared to one year ago, how would you rate [your/(SP's)] health in general now?
Would you say [your/(SP's)] health is . . .
FUTRHLTH
HFA2B
code one
DISHEAR
DIS1
yes/no
DISSEE
DISTEETH
SHOW CARD HF2
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?
Now, I would like to ask you about [your/(SP's)] health.
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?
DIS2
yes/no
[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing glasses?
BOX HF1
routing
IF P_DISTEETH=YES, GO TO DIS3-DISDECISION.
ELSE GO TO DIS2A-DISTEETH.
DIS2A
yes/no
DISDECISION
DIS3
yes/no
DISWALK
DIS4
yes/no
DISBATH
DIS5
yes/no
DISERRANDS
DIS6
yes/no
HELMTACT
HFA3
code one
[Have you/Has (SP)] lost all of [your/his/her] upper and lower natural (permanent) teeth?
(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED
(01) much better now than one year ago,
(02) somewhat better now than one year ago,
(03) about the same,
(04) somewhat worse now than one year ago, or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED
(01) it will get much better
(02) it will get somewhat better
(03) it will not change
(04) it will get somewhat worse
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFA2B - FUTRHLTH
DIS1 - DISHEAR
DIS2 - DISSEE
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS3 - DISDECISION
BOX HF1
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS3 - DISDECISION
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
[Do you/Does (SP)] have serious difficulty walking or climbing stairs?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
[Do you/Does (SP)] have difficulty dressing or bathing?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
Because of a physical, mental, or emotional condition, [do you/does (SP)] have difficulty doing errands alone (02) NO
such as visiting a doctor's office or shopping?
(-8) DON'T KNOW
(-9) REFUSED
(01) none of the time,
How much of the time during the past month has [your/(SP's)] health limited [your/(SP's)] social activities, like (02) some of the time,
visiting with friends or close relatives?
(03) most of the time, or
(04) all of the time?
Would you say . . .
(-8) DON'T KNOW
(-9) REFUSED
Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty
concentrating, remembering, or making decisions?
HFA2 - COMPHLTH
DIS4 - DISWALK
DIS5 - DISBATH
DIS6 - DISERRANDS
HFA3 - HELMTACT
HFB1-ECHELP
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ECHELP
HFB1
yes/no
ECTROUB
HFB2
code one
Next we are going to ask some questions about your vision and hearing.
[Do you/Does (SP)] wear eyeglasses or contact lenses?
Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... no trouble
seeing, a little trouble, a lot of trouble, or no usable vision?
[Have you/Has (SP)] been told that [you are/he is/she is] legally blind?
ECLEGBLI
EDOCEXAM
EDOCLAST
HFB2A
yes/no
HFB6
yes/no
BOX HFC
routing
HFB7
code one
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, they
cannot see well enough to drive.]
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)?
(01) YES
(02) NO
(-8) DON'T KNOW
[IF NEEDED: Please include any eye exams that took place during a visit that you may have already told me (-9) REFUSED
about.]
IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFB7-EDOCLAST.
ELSE GO TO BOX HFB1.
(01) NEVER HAD EYE EXAM BY EYE DOCTOR
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 5 YEARS
(04) 5 YEARS OR MORE
(-8) DON'T KNOW
(-9) REFUSED
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
How long has it been since [your/(SP's)] last eye examination by an eye doctor?
I have a couple of questions about [your/(SP’s)] last eye examination.
EDOCTYPE
EDOCTYOS
HFB7A
HFB7A
code one
verbatim text
Was the eye examination given by an optometrist, ophthalmologist or some other type of doctor or eye care
professional?
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who diagnoses and treats visual
health problems. An ophthalmologist is a doctor of medicine (M.D.) who specializes in surgery and diseases
of the eye.]
OTHER (SPECIFY)
Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in [your/(SP)’s] eyes?
EDOCDLAT
HFB7B
yes/no
ECATARAC
HFB7C
yes/no
EGLAUCOM
HFB7C
yes/no
ERETINOP
HFB7C
yes/no
EMACULAR
HFB7C
yes/no
BOX HFB1A
routing
(01) YES
(02) NO
(03) SP IS BLIND
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE SEEING
(02) A LITTLE TROUBLE SEEING
(03) A LOT OF TROUBLE SEEING
(04) NO USABLE VISION
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops
often make your eyes more sensitive to bright light and may cause temporary blurry vision.]
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
(01) OPTOMETRIST
(02) OPHTHALMOLOGIST
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED
(01) HFB2 - ECTROUB
(02) HFB2 - ECTROUB
(03) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
(01) HFB6 - EDOCEXAM
(02) HFB6 - EDOCEXAM
(03) HFB2A - ECLEGBLI
(04) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
HFB6 - EDOCEXAM
(01) HFB7A - EDOCTYPE
(02) HFB7 - EDOCLAST BOX HFC
(-8) BOX HFB1
(-9) BOX HFB1
(01) BOX HFB1
(02) HFB7A - EDOCTYPE
(03) HFB7A - EDOCTYPE
(04) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1
(996) BOX HFB1
(01) HFB7A - EDOCTYPE
(02) HFB7A - EDOCTYPE
(03) HFB7A – EDOCTYPE
(04) HFB7A – EDOCTYPE
(05) HFB7A – EDOCTYPE
(12) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1
(01) H7B7B - EDOCDLAT
(02) H7B7B - EDOCDLAT
(91) HFB7 - EDOCTYOS
(-8) BOX HFB1
(-9) BOX HFB1
H7B7B - EDOCDLAT
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/he/she] had any of these conditions.
(01) YES
(02) NO
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-8) DON'T KNOW
(-9) REFUSED
Cataracts?
(01) YES
(02) NO
Glaucoma?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
Diabetic retinopathy?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
Macular degeneration or age-related macular degeneration, also called AMD?
(-8) DON'T KNOW
(-9) REFUSED
IF ECATARAC=02/NO, GO TO BOX HFB1. ELSE GO TO HFB10 - ECCATOP.
HFB7C - ECATARAC
HFB7C - EGLAUCOM
HFB7C - ERETINOP
HFB7C - EMACULAR
BOX HFB1A
2020 MCBS Community Questionnaire
ECCATOP
ELASRSUR
HFQ - HEALTH STATUS AND FUNCTIONING
HFB10
yes/no
BOX HFB1
routing
HFB11
yes/no
[Have you/Has (SP)] ever had an operation for cataracts?
IF HFB7C - ERETINOP = 1/Yes OR HFB7C - EMACULAR = 1/Yes, GO TO HFB11 - ELASRSUR.
ELSE GO TO HFC1 - HCHELP.
Laser surgery to the back of the eye, or retina, is a commonly used treatment for diabetic retinopathy and
macular degeneration.
[Have you/Has (SP)] ever had laser surgery to the back of either eye for one of these conditions?
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the front of the eye used to correct
vision.]
HCHELP
HFC1
yes/no
HCTROUB
HFC2
code one
HCKNOWMC
HFC3
code one
HCCOMDOC
HFC4
code one
FOODTRBL
HFD1A
code one
HEIGHTFT
HFE1
numeric
HEIGHTIN
HFE1
numeric
WEIGHT
HFE1
numeric
DIFINTRO
HFHINTRO
no entry
DIFSTOOP
HFH1
code 1
DIFLIFT
HFH2
code 1
DIFREACH
HFH3
code 1
DIFWRITE
HFH4
code 1
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HFB1
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFC1 - HCHELP
(01) YES
(02) NO
[Do you/Does (SP)] use a hearing aid?
(03) SP IS DEAF
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a little trouble, a (03) A LOT OF TROUBLE HEARING
(04) DEAF
lot of trouble, or deaf?
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
How much trouble [do you/does (SP)] have finding out things [you need/he needs/she needs] to know about (02) A LITTLE TROUBLE
Medicare because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
(03) A LOT OF TROUBLE
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
How much trouble [do you/does (SP)] have communicating with [your/his/her] doctor or other health
(02) A LITTLE TROUBLE
professional because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
(03) A LOT OF TROUBLE
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
(02) A LITTLE TROUBLE
How much trouble [do you/does (SP)] have eating solid foods because of problems with [your/his/her] mouth
(03) A LOT OF TROUBLE
or teeth? Would you say [you have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
How tall [are you/is (SP)]?
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
How tall [are you/is (SP)]?
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
How much [do you/does (SP)] weigh?
(-8) DON'T KNOW
[WEIGHT SHOULD BE RECORDED IN POUNDS]
(-9) REFUSED
Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of activities.
(01) CONTINUE
Please tell me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some
(-7) Empty
difficulty, a lot of difficulty, or [is/are] not able to do it.
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would you say [you
(04) A LOT OF DIFFICULTY
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do (05) NOT ABLE TO DO IT
it?
(-8) Don't Know
(-9) Refused
SHOW CARD HF3
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10 pounds, like a (03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
heavy bag of groceries?
(05) NOT ABLE TO DO IT
(-8) Don't Know
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-9) Refused
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about reaching or extending arms above shoulder level?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-8) Don't Know
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-8) Don't Know
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) HFC2 - HCTROUB
(02) HFC2 - HCTROUB
(03) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
(01) HFD1A - FOODTRBL
(02) HFC3 - HCKNOWMC
(03) HFC3 - HCKNOWMC
(04) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
HFC4 - HCCOMDOC
HFD1A - FOODTRBL
HFE1 - HEIGHTFT
HFE1 - HEIGHTIN
HFE1 - WEIGHT
HFHINTRO - DIFINTRO
HFH1 - DIFSTOOP
HFH2 - DIFLIFT
HFH3 - DIFREACH
HFH4 - DIFWRITE
HFH5 - DIFWALK
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
SHOW CARD HF3
DIFWALK
HFH5
code 1
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]
PHYSACTINTRO
HFH10INT
no entry
VIGUNIT
HFH10
quantity unit
VIGNUM
HFH10
quantity unit
MODUNIT
HFH11
quantity unit
MODNUM
HFH11
numeric
MUSUNIT
HFH12
quantity unit
MUSNUM
HFH12
numeric
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large
(01) CONTINUE
increases in breathing or heart rate. Moderate activities cause small increases in breathing or heart rate. First
(-7) Empty
I will ask about the vigorous activities that [you do/(SP) does].
(01) NUMBER OF MINUTES PER DAY
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
(02) NUMBER OF HOURS PER DAY
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or
(03) NUMBER OF HOURS PER WEEK
heart rate?
(04) NUMBER OF HOURS PER MONTH
(96) NONE
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(-8) Don't Know
(-9) Refused
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
(01) [Continuous answer.]
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or
(-8) Don't Know
heart rate?
(-9) Refused
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
(03) NUMBER OF HOURS PER WEEK
bicycling, gardening, golf, swimming, or vacuuming?
(04) NUMBER OF HOURS PER MONTH
(96) NONE
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(-8) Don't Know
(-9) Refused
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
(01) continous answer
bicycling, gardening, golf, swimming, or vacuuming?
Now I’m going to ask you about activities [you/(SP)] may do to increase [your/(SP)'s] muscle strength or
(01) NUMBER OF MINUTES PER DAY
flexibility.
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength (04) NUMBER OF HOURS PER MONTH
or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?
(96) NONE
(-8) Don't Know
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(-9) Refused
In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength
or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?
HFH10INT - PHYSACTINTRO
HFH10 - VIGUNIT
(01) HFH10 - VIGNUM
(02) HFH10 - VIGNUM
(03) HFH10 - VIGNUM
(04) HFH10 - VIGNUM
(96) HFH11 - MODUNIT
(-8) HFH11 - MODUNIT
(-9) HFH11 - MODUNIT
HFH11 - MODUNIT
(01) HFH11 - MODNUM
(02) HFH11 - MODNUM
(03) HFH11 - MODNUM
(04) HFH11 - MODNUM
(96) HFH12 - MUSUNIT
(-8) HFH12 - MUSUNIT
(-9) HFH12 - MUSUNIT
(01) HFH12 - MUSUNIT
(01) HFH12 - MUSNUM
(02) HFH12 - MUSNUM
(03) HFH12 - MUSNUM
(04) HFH12 - MUSNUM
(96) HFJINTRO - MEDCONDINTRO
(-8) HFJINTRO - MEDCONDINTRO
(-9) HFJINTRO - MEDCONDINTRO
(01) Continunous answer
HFJINTRO - MEDCONDINTRO
(01) CONTINUE
(-7) Empty
BOX HFJ1
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
MEDCONDINTRO
HFJINTRO
no entry
BOX HFJ1
routing
Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH YEAR) has/Has] a doctor or
other health professional [ever] told [you/(SP)] that [you/he/she] had any of these conditions?
[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE SP HAS THE CONDITION.]
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS ROUND
(sample_person.P_OCHPB=1), GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
2020 MCBS Community Questionnaire
OCARTERY
HFJ1
HFQ - HEALTH STATUS AND FUNCTIONING
yes/no
[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...
hardening of the arteries or arteriosclerosis?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] [still has/still have/had/has/have...]
OCHBP
YRHBP
OCMYOCAR
YRMYOCAR
OCCHD
HFJ2
BOX HFJ2
routing
HFJ3
yes/no
OCCFAIL
BOX HFJ3
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had a myocardial infarction or heart attack?
HFJ5
HFJ6
HFJ7
HFJ8
HFJ9
yes/no
routing
yes/no
yes/no
routing
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] angina pectoris or coronary heart disease?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had an episode of angina pectoris or coronary heart disease?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] congestive heart failure?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ14 - OCOTHHRT.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had an episode of congestive heart failure?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
OCHRTCND
HFJ14
yes/no
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ2
(02) HFJ4 - OCMYOCAR
(-8) HFJ4 - OCMYOCAR
(-9) HFJ4 - OCMYOCAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
(-9) Refused
the rhythm of the heartbeat, such as atrial fibrillation.]
[a new episode of] any other heart condition?
[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]
BOX HFJ8
HFJ2 - OCHBP
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] still
(01) YES
had hypertension or high blood pressure?
(02) NO
(-8) Don't Know
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
(-9) Refused
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
(02) NO
[you/he/she] had...]
(-8) Don't Know
(-9) Refused
a myocardial infarction or heart attack?
yes/no
BOX HFJ5
YRCFAIL
hypertension, sometimes called high blood pressure?
HFJ4
BOX HFJ4
YRCHD
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YRHRTCND.
ELSE GO TO HFJ16 - OCSTROKE.
HFJ4 - OCMYOCAR
(01) BOX HFJ3
(02) HFJ6 - OCCHD
(-8) HFJ6 - OCCHD
(-9) HFJ6 - OCCHD
HFJ6 - OCCHD
(01) BOX HFJ4
(02) HFJ8 - OCCFAIL
(-8) HFJ8 - OCCFAIL
(-9) HFJ8 - OCCFAIL
HFJ8 - OCCFAIL
(01) BOX HFJ5
(02) HFJ14 - OCHRTCND
(-8) HFJ14 - OCHRTCND
(-9) HFJ14 - OCOTHHRT
HFJ14 - OCHRTCND
(01) BOX HFJ8
(02) HFJ16 - OCSTROKE
(-8) HFJ16 - OCSTROKE
(-9) HFJ16 - OCSTROKE
2020 MCBS Community Questionnaire
YRHRTCND
OCSTROKE
YRSTROKE
HFJ15
HFQ - HEALTH STATUS AND FUNCTIONING
yes/no
HFJ16
yes/no
BOX HFJ9
routing
HFJ17
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had an episode of any other heart condition?
(01) YES
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
(-9) Refused
the rhythm of the heartbeat, such as atrial fibrillation.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
(01) YES
(02) NO
a stroke, a brain hemorrhage, or a cerebrovascular accident?
(-8) Don't Know
(-9) Refused
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had a stroke, a brain hemorrhage, or a cerebrovascular accident?
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had high cholesterol?
HFJ17A
yes/no
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had high cholesterol?
YRCHOLES
HFJ17B
yes/no
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
BOX HFJ29
IF ROUND= FALL 2018 ROUND 82, GO TO HFJ45-BLOSWGHT.
ELSE IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ45-BLOSWGHT.
ELSE IF be P_EVRLWGHT ^= YES 0 THEN GO TO HFJ46-CLOSWGHT.
ELSE GO TO HFJ18 - OCCSKIN.
BLOSWGHT
HFJ45
yes/no
To lower risk for certain diseases, [have you/ has (SP)] ever been told by a doctor or health professional to
control weight or lose weight?
CLOSWGHT
HFJ46
yes/no
To lower risk for certain diseases, since (SAMPLE_PERSON.DATE_FALLRND) [have you/ has (SP)] been
told by a doctor or health professional to control weight or lose weight?
[I've recorded that [you/(SP)] previously reported having had skin cancer.]
OCCSKIN
HFJ18
BOX HFJ10
YRCSKIN
HFJ19
yes/no
routing
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new occurrence of] skin cancer?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 - OCCANCER.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had an occurrence of skin cancer?
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or cancer of the
[READ RESPONSES BELOW].]
OCCANCER
HFJ20
yes/no
(01) BOX HFJ9
(02) HFJ17A - OCCHOLES
(-8) HFJ17A - OCCHOLES
(-9) HFJ17A - OCCHOLES
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17 - YRSTROKE.
ELSE GO TO HFJ17A - OCCHOLES.
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
OCCHOLES
HFJ16 - OCSTROKE
[Since (LAST HF MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had any [other] kind of cancer, malignancy, or tumor other than skin cancer?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ17A - OCCHOLES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFJ17B - YRCHOLES
(2) BOX HFJ29
(-8) BOX HFJ29
(-9) BOX HFJ29
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ29
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ18 - OCCSKIN
HFJ18 - OCCSKIN
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ10
(02) HFJ20 - OCCANCER
(-8) HFJ20 - OCCANCER
(-9) HFJ20 - OCCANCER
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ20 - OCCANCER
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ11
(02) BOX HFJ13
(-8) BOX HFJ13
(-9) BOX HFJ13
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ22 - OCCCODE
INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.
BOX HFJ11
YRCANCER
HFJ21
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - OCCCODE.
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had any kind of cancer, malignancy, or tumor other than skin cancer?
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
OCCCODE
HFJ22
code all
OCCOS
HFJ22
verbatim text
BOX HFJ13
routing
OCARTHRH
OCOSARTH
OCARTH
YRARTHRD
(01) LUNG
(02) COLON (BOWEL)
(03) BREAST
(04) UTERUS
(05) PROSTATE
(06) BLADDER
(07) OVARY
(08) STOMACH
(09) CERVIX
(10) BRAIN
(11) KIDNEY
SHOW CARD HF4
(12) THROAT
(16) BLOOD
[Since the first time a doctor or other health professional told [you/(SP)] that [you/he/she] had a cancer,
(17) BONE
malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the cancer or tumor other than skin
(18) ESOPHAGUS
cancer found?
(19) GALL BLADDER
(20) LARYNX (WINDPIPE)
[PROBE: Any other part?]
(21) LEUKOCYTES (LEUKEMIA)
CHECK ALL THAT APPLY
(22) LIVER
(23) LYMPH NODES (LYMPHOMA)
(24) MOUTH/TONGUE/LIP
(25) PANCREAS
(26) RECTUM
(27) SOFT TISSUE/FAT
(28) TESTIS
(29) THYROID
(91) OTHER
(-8) Don't Know
(-9) Refused
Specify the part of parts of your body where the cancer or tumor was found.
(01) [Continuous answer.]
IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCARTHRH=1), GO TO BOX HFJ13B.
ELSE GO TO HFJ24 - OCARTHRH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
rheumatoid arthritis?
(-9) Refused
IF SP HAS EVER REPORTED HAVING OSTEOARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCOSARTH=1), GO TO BOX HFJ14.
ELSE GO TO HFJ24B-OCOSARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
osteoarthritis?
(-9) Refused
IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND [sample_person.P_OCARTH=1], GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(you/he/she) had...]
(01) YES
(02) NO
arthritis, other than rheumatoid or osteoarthritis?
(-8) Don't Know
(-9) Refused
HFJ24
yes/no
BOX HFJ13B
routing
HFJ24B
yes/no
BOX HFJ14
routing
HFJ25
yes/no
BOX HFJ15
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.
HFJ26
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had arthritis, other than rheumatoid or osteoarthritis, in any part of [your/his/her] body?
BOX HFJ16
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.
[Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had...]
OCMENTAL
HFJ28
BOX HFJ16A
OCALZMER
HFJ29A
BOX HFJ16B
OCDEMENT
HFJ29B
yes/no
routing
yes/no
routing
yes/no
an intellectual disability?
[EXPLAIN IF NECESSARY:] This is also known as intellectual development disorder or a general learning
disability. It was formerly known as mental retardation.
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCALMER=1), GO TO BOX HFJ30.
ELSE GO TO HFJ29A - OCALZMER.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
Alzheimer's disease?
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND
(sample_person.P_OCDEMENT=1), GO TO BOX HFJ30
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
any type of dementia other than Alzheimer's disease?
(01) BOX HFJ13
(02) BOX HFJ13
(03) BOX HFJ13
(04) BOX HFJ13
(05) BOX HFJ13
(06) BOX HFJ13
(07) BOX HFJ13
(08) BOX HFJ13
(09) BOX HFJ13
(10) BOX HFJ13
(11) BOX HFJ13
(12) BOX HFJ13
(16) BOX HFJ13
(17) BOX HFJ13
(18) BOX HFJ13
(19) BOX HFJ13
(20) BOX HFJ13
(21) BOX HFJ13
(22) BOX HFJ13
(23) BOX HFJ13
(24) BOX HFJ13
(25) BOX HFJ13
(26) BOX HFJ13
(27) BOX HFJ13
(28) BOX HFJ13
(29) BOX HFJ13
(91) HFJ22 - OCCOS
(-8) BOX HFJ13
(-9) BOX HFJ13
BOX HFJ13
(01) BOX HFJ15
(02) BOX HFJ16
(-8) BOX HFJ16
(-9) BOX HFJ16
BOX HFJ14
(01) BOX HFJ15
(02) BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ16A
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ30 BOX HFJ16B
(02) BOX HFJ16B
(-8) BOX HFJ16B
(-9) BOX HFJ16B
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ30
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
BOX HFJ30
IF ROUND= FALL 2018 ROUND 82, GO TO HFJ47-BASKDEPRS.
ELSEIF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ47-BASKDEPRS.
ELSE IF P_EVRDPRSS ^= YES 0 THEN GO TO HFJ48-CASKDEPRS.
ELSE GO TO HFJ30AA - OCDEPRSS.
BASKDEPRS
HFJ47
yes/no
Has a doctor or other health professional ever asked [you/(SP)] if there was a period of time when
[you/he/she] felt sad, empty, or depressed?
CASKDEPRS
HFJ48
yes/no
Since (SAMPLE_PERSON.DATE_FALLRND), has a doctor or other health professional asked [you/(SP)] if
there was a period of time when [you/he/she] felt sad, empty, or depressed?
OCDEPRSS
HFJ30AA
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
depression?
BOX HFJ17A
YRDEPRSS
HFJ30BB
routing
yes/no
HFJ30A
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had depression?
a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
BOX HFJ17B
YRPSYCHO
HFJ31A
BOX HFJ19
OCOSTEOP
OCBRKHIP
YRBRKHIP
OCPARKIN
HFJ32
OCPPARAL
yes/no
routing
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND
(sample_person.P_OCOSTEOP=1), GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
osteoporosis, sometimes called fragile or soft bones?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]]
yes/no
BOX HFJ20
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.
HFJ34
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had a broken hip?
BOX HFJ21
routing
HFJ35
HFJ36
HFJ37
yes/no
routing
yes/no
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ30A - OCPSYCHO
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ17B
(02) BOX HFJ19
(-8) BOX HFJ19
(-9) BOX HFJ19
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ19
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ33 - OCBRKHIP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ20
(02) BOX HFJ21
(-8) BOX HFJ21
(-9) BOX HFJ21
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ21
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ22
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ37 - OCPPARAL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ23
(02) BOX HFJ24
(-8) BOX HFJ24
(-9) BOX HFJ24
(01) BOX HFJ17A
(02) HFJ30A - OCPSYCHO
(-8) HFJ30A - OCPSYCHO
(-9) HFJ30A - OCPSYCHO
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.
HFJ33
BOX HFJ22
OCEMPHYS
routing
HFJ30AA - OCDEPRSS
HFJ30AA - OCDEPRSS
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
OCPSYCHO
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
a broken hip?
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
Parkinson's disease?
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
emphysema, asthma, or COPD?
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE
IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
complete or partial paralysis?
2020 MCBS Community Questionnaire
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.
HFJ38
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she]
had complete or partial paralysis?
BOX HFJ24
routing
HFJ39
yes/no
BOX HFJ25
routing
BOX HFJ23
YRPPARAL
OCAMPUTE
HAVEPROS
HFQ - HEALTH STATUS AND FUNCTIONING
HFJ40
yes/no
IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS ROUND
(sample_person.P_OCAMPUTE=1), GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.
IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT ASK. OTHERWISE, (01) YES
ASK:
(02) NO
(-8) Don't Know
(-9) Refused
What about absence or loss of an arm or a leg?
IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO HFJ41A OCBETES BOX HFCA.
ELSE GO TO HFJ40 - HAVEPROS.
[[Before (you/[SP]) had prostate surgery, did a doctor or other health professional ever tell/Since (LAST HF
MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that [you/he] had...]
an enlarged prostate or benign prostatic hypertrophy (BPH)?
BOX HFJ26
YRPROST
OCBETES
YRBETES
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ41
yes/no
BOX HFCA
routing
IF P_OCBETES=YES, GO TO BOX HFCB.
ELSE IF SP IS IN THE BASELINE SAMPLE (sample_person.INTTYPE=3), GO TO HFJ41A-OCBETES.
ELSE GO TO YRBETES-YRBETES.
YRBETES
yes/no
yes/no
BOX HFJ25
(01) BOX HFJ26
(02) HFJ41A - OCBETES BOX HFCA
(-8) HFJ41A - OCBETES BOX HFCA
(-9) HFJ41A - OCBETES BOX HFCA
IF SP IS IN THE BASELINE SAMPLE (sample_person.INTTYPE=3), GO TO HFJ41 - YRPROST.
ELSE GO TO HFJ41A - OCBETES BOX HFCA.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he] had an (02) NO
(-8) Don't Know
enlarged prostate or benign prostatic hypertrophy (BPH)?
(-9) Refused
HFJ41A
BOX HFJ24
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had any type of diabetes,
including:
(01) YES
(02) NO
(-8) Don't Know
sugar diabetes, high blood sugar, (borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
(-9) Refused
diabetes, or pre-diabetes)?
Since [SAMPLE_PERSON.DATE_FALLRND], has a doctor or other health professional ever told [you/(SP)]
(01) YES
that [you/he/she] had any type of diabetes, including:
(02) NO
(-8) Don't Know
sugar diabetes, high blood sugar, (borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
(-9) Refused
diabetes, or pre-diabetes)?
HFJ41A - OCBETES BOX HFCA
(01) HFJ41B - OCDTYPE
(02) BOX HFJ27
(-8) BOX HFJ27
(-9) BOX HFJ27
(01) HFJ41B - OCDTYPE
(02) BOX HFJ27
(-8) BOX HFJ27
(-9) BOX HFJ27
SHOW CARD HF5
Looking at this card, please tell me which type of diabetes the doctor or other health professional said that
[you have/(SP) has].
OCDTYPE
HFJ41B
code 1
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes.
This type of diabetes usually develops during childhood or adolescence; but, it also can develop in adults.
“Type 2” was formerly called “non-insulin dependent” or “adult-onset” diabetes. Until recently, this type of
diabetes was found only in adults; but, now it is also occurring in children.]
(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
(04) PRE-DIABETES
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
(-8) Don't Know
(-9) Refused
(01) HFJ41C - OCDVISIT BOX HFCB
(02) HFJ41C - OCDVISIT BOX HFCB
(03) HFJ41C - OCDVISIT BOX HFCB
(04) HFJ41C - OCDVISIT BOX HFCB
(05) HFJ41C - OCDVISIT BOX HFCB
(91) HFJ41B - OCDTYPOS
(-8) HFJ41C - OCDVISIT BOX HFCB
(-9) HFJ41C - OCDVISIT BOX HFCB
(01) [Continuous answer.]
HFJ41C - OCDVISIT BOX HFCB
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ27
SOME OTHER TYPE (SPECIFY)
OCDTYPOS
OCDVISIT
HFJ41B
verbatim text
BOX HFCB
routing
HFJ41C
BOX HFJ27
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
IF (P_OCBETES ^= YES AND (OCBETES = YES or YRBETES = YES)) OR (P_OCBETES = YES AND
P_OCDVISIT ^= YES), GO TO HFJ41C-OCDVISIT.
ELSE GO TO BOX HFJ27.
yes/no
[Were you/Was (SP)] told on two or more different visits that [you/he/she] had diabetes?
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE
ELIGIBILITY WAS UNDER 65 (sample_person.INTTYPE=3 and AGECALC<65 and greater than 0) THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 - EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 - EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF CURRENT
MEDICARE ELIGIBILITY WAS NOT UNDER 65 THEN GO TO HFPINTRO - HLTHCAREINTRO.
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW]. [Was this/Were any of
these] the original cause of [your/(SP's)] becoming eligible for Medicare?
EMCOND
HFJ42
yes/no
(01) YES
(02) NO
(-8) Don't Know
[NOTE THAT CONDITIONS MAY NOT BE DISPLAYED WITH THE EXACT CONDITION NAME THAT WAS (-9) Refused
USED EARLIER IN THE INTERVIEW (E.G., HYPERTENSION CAN ALSO BE CALLED HIGH BLOOD
PRESSURE AT DIFFERENT QUESTIONS).]
[LIST ALL CONDITIONS WHERE "YES" ANSWER RECORDED AT HFJ1 THROUGH HFJ41C]
(01) BOX HFJ28
(02) HFJ43 - EMCAUSEVB
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO
2020 MCBS Community Questionnaire
EMCAUSEVB
HFQ - HEALTH STATUS AND FUNCTIONING
HFJ43
verbatim text
BOX HFJ28
routing
What was the original cause of [your/(SP's)] becoming eligible for Medicare?
RECORD VERBATIM.
IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO HFPINTRO - HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.
Which of these conditions was the cause of [your/(SP's)] becoming eligible for Medicare?
(01) [Continuous answer.]
(01) ARTERIES HARDENING
(02) HYPERTENSION
(03) HEART ATTACK
(04) HEART DISEASE
(05) CONGESTIVE HEART FAILURE
(06) HEART VALVE PROBLEM
(07) HEART RHYTHM PROBLEM
(08) OTHER HEART PROBLEM
(09) STROKE OR HEMORRHAGE
(10) SKIN CANCER
(11) CANCER/TUMOR
(12) RHEUMATOID ARTHRITIS
(26) OSTEOARTHRITIS
(13) OTHER ARTHRITIS
(14) INTELLECTUAL DISABILITY
(15) ALZHEIMER'S
(16) DEMENTIA
(17) DEPRESSION
(18) MENTAL DISORDER
(19) OSTEOPOROSIS
(20) BROKEN HIP
(21) PARKINSON'S
(22) EMPHYSEMA/ASTHMA/COPD
(23) PARALYSIS
(24) LOSS OF LIMB
(25) DIABETES
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
EMCODE
HFJ44
code all
EMOS
HFJ44
verbatim text
OTHER (SPECIFY)
HLTHCAREINTRO
HFPINTRO
no entry
Now I want to ask you about some things that [you/(SP)] may be doing to maintain [your/his/her] health, either (01) CONTINUE
by getting tested for health problems or by taking care of conditions that [you have/she has/he has].
(-7) Empty
routing
IF (P_OCBETES ^= 1/YES) AND (HFJ41A – OCBETES = 1/Yes or YRBETES - YRBETES = 1/YES) AND
(HFJ41B - OCDTYPE ^= 5/GESTATIONAL 1/TypeOne, 2/TypeTwo, 3/Borderline, 4/PreDiabetes, 91/Other,
DK, or RF), GO TO HFP1 - DIAAGE.
ELSE GO TO HFP21 - DIAEVERT BOX HFC2.
BOX HFP1A
DIAAGE
HFP1
numeric
[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.
I recorded that [you were/(SP) was] told by a doctor or other health professional that [you have/she has/he
has] [Type 1 diabetes/Type 2 diabetes/borderline diabetes/pre-diabetes/diabetes].
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had diabetes?
BOX HFP2
DIAPRGNT
DIAINSUL
DIAMEDS
DIATEST
DIASORES
DIAPRESS
DIAASPRN
HFP2
HFP4
HFP4
HFP4
HFP4
HFP4
HFP4
BOX HFP3
routing
yes/no
list
list
list
list
list
list
routing
IF THE SP IS FEMALE (ROSTSEX=2) AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR (HFP1 – DIAAGE =
DK OR RF), GO TO HFP2 - DIAPRGNT.
ELSE GO TO HFP4 - DIAINSUL.
Did [you/(SP)] have diabetes only during a pregnancy?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take insulin?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take prescription diabetes pills or oral diabetes medicine?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
test [your/his/her] blood for sugar or glucose?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
check for sores or irritations on [your/his/her] feet?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
measure [your/his/her] blood pressure at home?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take aspirin regularly for [your/his/her] diabetes?
IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE.
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFPINTRO - HLTHCAREINTRO
(01) HFPINTRO - HLTHCAREINTRO
(02) HFPINTRO - HLTHCAREINTRO
(03) HFPINTRO - HLTHCAREINTRO
(04) HFPINTRO - HLTHCAREINTRO
(05) HFPINTRO - HLTHCAREINTRO
(06) HFPINTRO - HLTHCAREINTRO
(07) HFPINTRO - HLTHCAREINTRO
(08) HFPINTRO - HLTHCAREINTRO
(09) HFPINTRO - HLTHCAREINTRO
(10) HFPINTRO - HLTHCAREINTRO
(11) HFPINTRO - HLTHCAREINTRO
(12) HFPINTRO - HLTHCAREINTRO
(13)HFPINTRO - HLTHCAREINTRO
(14) HFPINTRO - HLTHCAREINTRO
(15) HFPINTRO - HLTHCAREINTRO
(16) HFPINTRO - HLTHCAREINTRO
(17) HFPINTRO - HLTHCAREINTRO
(18) HFPINTRO - HLTHCAREINTRO
(19) HFPINTRO - HLTHCAREINTRO
(20) HFPINTRO - HLTHCAREINTRO
(21) HFPINTRO - HLTHCAREINTRO
(22) HFPINTRO - HLTHCAREINTRO
(23) HFPINTRO - HLTHCAREINTRO
(24) HFPINTRO - HLTHCAREINTRO
(25HFPINTRO - HLTHCAREINTRO
(91) HFJ44 - EMOS
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO
HFPINTRO - HLTHCAREINTRO
BOX HFP1A
BOX HFP2
(01) HFP21 - DIAEVERT BOX HFC2
(02) HFP4 - DIAINSUL
(-8) HFP21 - DIAEVERT BOX HFC2
(-9) HFP21 - DIAEVERT BOX HFC2
HFP4 - DIAMEDS
HFP4 - DIATEST
HFP4 - DIASORES
HFP4 - DIAPRESS
HFP4 - DIAASPRN
BOX HFP3
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
INSUTAKE
HFP5
quantity unit
How often [do you/does (SP)] take insulin?
INSUDAY
INSUWEEK
HFP5
HFP5
quantity unit
quantity unit
BOX HFP4
routing
How often [do you/does (SP)] take insulin?
How often [do you/does (SP)] take insulin?
IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
MEDSTAKE
HFP6
quantity unit
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
MEDDAY
MEDWEEK
MEDMONTH
HFP6
HFP6
HFP6
quantity unit
quantity unit
quantity unit
BOX HFP5
routing
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
TESTTAKE
HFP7
quantity unit
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
TESTDAY
HFP7
quantity unit
TESTWEEK
HFP7
quantity unit
TESTMNTH
HFP7
quantity unit
TESTYEAR
HFP7
quantity unit
BOX HFP6
routing
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) USE INSULIN PUMP
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]
(01) HFP5 - INSUDAY
(02) HFP5 - INSUWEEK
(03) BOX HFP4
(-8) BOX HFP4
(-9) BOX HFP4
BOX HFP4
BOX HFP4
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]
(01) [Continuous answer.]
(01) HFP6 - MEDDAY
(02) HFP6 - MEDWEEK
(03) ) HFP6 - MEDMONTH
(-8) BOX HFP5
(-9) BOX HFP5
BOX HFP5
BOX HFP5
BOX HFP5
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused
(01) HFP7 - TESTDAY
(02) HFP7 - TESTWEEK
(03) HFP7 - TESTMNTH
(04) HFP7 - TESTYEAR
(-8) BOX HFP6
(-9) BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
[PROBE: Include times when they are checked by a family member or friend, but do not include times when (04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
they are checked by a health professional.]
(-9) Refused
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
SORECHEK
HFP8
quantity unit
SOREDAY
HFP8
quantity unit
SOREWEEK
HFP8
quantity unit
SOREMNTH
HFP8
quantity unit
SOREYEAR
HFP8
quantity unit
DIATENYR
HFP10
yes/no
DIADRSAW
HFP11
numeric
DIAHEMOC
HFP13
numeric
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
(01) HFP8 - SOREDAY
(02) HFP8 - SOREWEEK
(03) HFP8 - SOREMNTH
(04) HFP8 - SOREYEAR
(-8) HFP10 - DIATENYR
(-9) HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) YES
(02) NO
In the past year has a doctor or other health professional examined [your/his/her] feet for sores or irritations?
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
About how many times in the past year [have you/has (SP)] seen a doctor or other health professional for
(-8) Don't Know
[your/his/her] diabetes?
(-9) Refused
A test of hemoglobin "A one C" measures the average level of blood sugar over the past three months. It is (01) [Continuous answer.]
usually done in a doctor's office. About how many times in the past year has a doctor or other health
(-8) Don't Know
professional checked [you/(SP)] for hemoglobin "A one C"?
(-9) Refused
HFP11 - DIADRSAW
HFP13 - DIAHEMOC
HFP14 - DIACTRLD
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
SHOW CARD HF6
DIACTRLD
DIAHYPO
HFP14
HFP14A1
code 1
yes/no
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, some of the
time, a little of the time, or none of the time? By "well controlled" we mean a recent hemoglobin "A one C"
result of 7.5 or less or an average fasting blood test of 140 or less.
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an
insulin reaction?
Please think about the most serious episode of hypoglycemia that [you have/(SP) has] experienced in the
past year.
DIAHYPTR
HFP14A2
BOX HFCC
code 1
routing
DIAFTEVR
HFP14A3
yes/no
DIAFEET
HFP14A
yes/no
BOX HFCD
routing
HFP14B
list
DIANEURO
[Were you/Was (SP)] able to treat [yourself/himself/herself] by taking some form of sugar, did [you/he/she]
require treatment from others, or did [you/he/she] require treatment by a hospital?
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being treated in the emergency room or
outpatient department of a hospital, or being admitted as an inpatient.]
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) , GO TO HFP14A3-DIAFTEVR.
ELSE GO TO HFP14A-DIAFEET.
(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
(04) A LITTLE OF THE TIME
(05) NONE OF THE TIME
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] ever had any problems with [your/his/her] feet as a result of [your/his/her] diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Do you/Does (SP)] currently have any problems with [your/his/her] feet as a result of [your/his/her] diabetes?
(-8) Don't Know
(-9) Refused
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIANEURO.
ELSE IF P_DNEURO ^= YES, GO TO YRDNEURO-YRDNEURO.
ELSE GO TO BOX HFCE.
People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
HFP14A1 - DIAHYPO
(01) HFP14A2 - DIAHYPTR
(02) HFP14A - DIAFEET
(-8) HFP14A - DIAFEET
(-9) HFP14A - DIAFEET
HFP14A3 - DIAFTEVR BOX HFCC
(01) HFP14A - DIAFEET
(02) HFP15 - DIAEYPRB
(-8) HFP15 - DIAEYPRB
(-9) HFP15 - DIAEYPRB
HFP14B - DIANEURO BOX HFCD
HFP14B - DIACIRCF BOX HFCE
Neuropathy or nerve damage, which may cause pain or numbness in the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
YRDNEURO
YRDNEURO
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/he/she] had…
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP14B - DIAULCER BOX HFCF.
Neuropathy or nerve damage, which may cause pain or numbness in the feet?
BOX HFCE
DIACIRCF
HFP14B
routing
list
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIACIRCF.
ELSE IF P_DCIRCF ^= YES, GO TO YRDCIRCF-YRDCIRCF.
ELSE GO TO BOX HFCF.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Poor circulation or blood flow in the feet?
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
YRDCIRCF
YRDCIRCF
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/he/she] had…
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCF
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP14B - DIASKINC BOX HFCG
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCG
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP15 - DIAEYPRB
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP15 - DIAEYPRB
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP16A1 - DIAKDPEV BOX HFCH
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP16 - DIAKDPRB
(02) HFP17 - DIAMNGE BOX HFC1
(-8) HFP17 - DIAMNGE BOX HFC1
(-9) HFP17 - DIAMNGE BOX HFC1
(01) HFP16A - DIAKIDNY BOX HFCI
(02) HFP17 - DIAMNGE BOX HFC1
(-8) HFP17 - DIAMNGE BOX HFC1
(-9) HFP17 - DIAMNGE BOX HFC1
Poor circulation or blood flow in the feet?
BOX HFCF
DIAULCER
HFP14B
routing
list
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIAULCER.
ELSE IF P_DULCER ^= YES, GO TO YRDULCER-YRDULCER.
ELSE GO TO BOX HFCG.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Foot ulcers?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
YRDULCER
YRDULCER
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has (SP)] been told by a doctor or other health
professional that [you/he/she] had…
Foot ulcers?
BOX HFCG
DIASKINC
HFP14B
routing
list
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIASKINC.
ELSE IF P_DSKINC ^= YES, GO TO YRDSKINC-YRDSKINC.
ELSE GO TO BOX HFCH.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Calluses, infections, or other skin changes affecting the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]
YRDSKINC
YRDSKINC
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/he/she] had…
Calluses, infections, or other skin changes affecting the feet?
DIAEYPRB
HFP15
yes/no
[Do you/Does (SP)] have any problems with [your/his/her] eyes as a result of [your/his/her] diabetes?
BOX HFCH
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP16A1-DIAKDPEV.
ELSE GO TO HFP16-DIAKDPRB.
DIAKDPEV
HFP16A1
yes/no
DIAKDPRB
HFP16
yes/no
[Have you/Has (SP)] ever had any problems with [your/his/her] kidneys as a result of [your/his/her] diabetes?
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]
[Do you/Does (SP)] currently have any problems with [your/his/her] kidneys as a result of [your/his/her]
diabetes?
2020 MCBS Community Questionnaire
BOX HFCI
HFQ - HEALTH STATUS AND FUNCTIONING
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP16A-DIAKIDNY.
ELSE IF P_DKIDNY ^= YES, GO TO YRDKIDNY-YRDKIDNY.
ELSE GO TO BOX HFC1.
DIAKIDNY
HFP16A
yes/no
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/she has/he has]
chronic kidney disease?
YRDKIDNY
YRDKIDNY
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [Have you/Has (SP)] been told by a doctor or other health
professional that [you have/she has/he has] chronic kidney disease?
BOX HFC1
routing
IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP17-DIAMNGE.
ELSE GO TO HFP17A-CDIAMNGE.
DIAMNGE
HFP17
yes/no
[Have you/Has (SP)] ever participated in a diabetes self-management course or class, or received special
training on how [you/he/she] can manage [your/his/her] diabetes?
CDIAMNGE
CDIAMNGE
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/has (SP)] participated in a diabetes selfmanagement course or class, or received special training on how [you/he/she] can manage [your/his/her]
diabetes?
DIATRAIN
HFP18
code 1
BOX HFP7
routing
DIAKNOW
HFP19
code 1
DIASUPPS
HFP20
yes/no
BOX HFC2
routing
DIAEVERT
CDIAEVER
HFP21
HFP21A
yes/no
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
When was the most recent time that [you/(SP)] participated in a diabetes self-management course or class or (02) 1 YEAR TO LESS THAN 2 YEARS
received special training on how [you/he/she] can manage [your/his/her] diabetes?
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE
(05) 4 YEARS TO LESS THAN 5 YEARS
MOST RECENT TIME.]
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.
(01) just about everything you need to know,
(02) most of what you need to know,
(03) some of what you need to know,
SHOW CARD HF7
(04) a little of what you need to know, or
(05) almost none of what you need to know about
How much do you think you know about managing your diabetes? Do you know . . .
managing your diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Before today, did you know that Medicare now helps pay the cost of diabetic testing supplies and self(-8) Don't Know
management education for people with diabetes?
(-9) Refused
IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP21-DIAEVERT.
ELSE GO TO HFP21A-CDIAEVER.
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
(01) YES
have/she has/he has] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had a blood test to see if [you have/she has/he has] diabetes?
(-9) Refused
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
(01) YES
have/she has/he has] diabetes.]
(02) NO
(-8) Don't Know
Since [SAMPLE_PERSON.DATE_FALLRND, [have you/has (SP)] had a blood test to see if [you have/she
(-9) Refused
has/he has] diabetes?
HFP17 - DIAMNGE
BOX HFC1
BOX HFC1
(01) HFP18 - DIATRAIN
(02) BOX HFP7
(-8) BOX HFP7
(-9) BOX HFP7
BOX HFP7
BOX HFP7
HFP20 - DIASUPPS
BOX HFR1
(01) HFP22 - DIARECNT
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8
(01) HFP24 - DIARISK
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
DIARECNT
HFP22
code 1
When was the most recent time [you were/(SP) was] tested for diabetes?
BOX HFP8
routing
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.
DIAAWARE
HFP23
yes/no
Before today, were you aware that there is a blood test to determine if a person has diabetes?
DIARISK
HFP24
yes/no
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
diabetes?
DIASIGNS
HFP25
yes/no
In the past year, [have you/has (SP)] received any information about the signs, symptoms, or risk factors for
diabetes?
routing
IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS UNKNOWN P_COLHEAR=.)
AND (SP HAS NOT REPORTED HAVING COLON, RECTAL OR BOWEL CANCER IN THE CURRENT
ROUND OR IN A PREVIOUS ROUND (OCCCODE not in 02 and P_OCCCOLON^=1), GO TO HFR1 COLHEAR.
ELSE GO TO BOX HFS1.
BOX HFR1
COLHEAR
COLHTEST
CCOLHTES
COLHKIT
HFR1
yes/no
BOX HFC3
routing
HFR3
yes/no
HFR3A
yes/no
BOX HFC4
routing
HFR4
yes/no
COLFDOC
HFR4A
yes/no
COLCARD
HFR5
yes/no
BOX HFC5
routing
Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.
Before today, had you ever heard of colorectal or colon cancer?
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR3 - COLHTEST.
ELSE GO TO HFR3A - CCOLHTES.
The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at (01) YES
the patient’s home. The test is then sent to a laboratory for the results to be determined.
(02) NO
(-8) Don't Know
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the
(-9) Refused
stool?
The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at (01) YES
the patient’s home. The test is then sent to a laboratory for the results to be determined.
(02) NO
(-8) Don't Know
Since (SAMPLE_PERSON.DATE_FALLRND), Has a doctor or other health professional ever given
(-9) Refused
[you/(SP)] a home testing kit to test for blood in the stool?
IF P_COLHKIT=YES, GO TO HFR4A - COLFDOC.
ELSE GO TO HFR4-COLHKIT.
(01) YES
(02) NO
Have you ever heard of this home testing kit?
(-8) Don't Know
(-9) Refused
(01) YES
Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the stool (02) NO
while [you/(SP)] [were/was] at the doctor’s office?
(-8) Don't Know
(-9) Refused
Did [you/(SP)] complete the samples and return them for [your/his/her] most recent test?
(01) YES
(02) NO
[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects (-8) Don't Know
(-9) Refused
invisible traces of blood found in the stool.]
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR7 - COLRECNT.
ELSE GO TO BOX HFC6.
HFP24 - DIARISK
HFP24 - DIARISK
HFP25 - DIASIGNS
BOX HFR1
HFR3 - COLHTEST
BOX HFC3
(01) HFR5 - COLCARD
(02) HFR4 - COLHKIT BOX HFC4
(-8) HFR4 - COLHKIT BOX HFC4
(-9) HFR4 - COLHKIT BOX HFC4
(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4
HFR4A - COLFDOC
(01) HFR7 - COLRECNT
(02) HFR8 - COLSCOPY
(-8) HFR8 - COLSCOPY
(-9) HFR8 - COLSCOPY
HFR7 - COLRECNT
BOX HFC5
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
COLRECNT
COLSCOPY
HFR7
code 1
BOX HFC6
routing
HFR8
yes/no
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects (05) 4 YEARS TO LESS THAN 5 YEARS
invisible traces of blood found in the stool.]
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
When did [you/(SP)] have [your/his/her] most recent blood stool test [(using a home testing kit)/(at the
doctor's office)]?
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR8-COLSCOPY.
ELSE GO TO HFRA8-CCOLSCOP.
Another test for early signs of colon cancer is performed in the doctor's office. The doctor uses a flexible
lighted tube to examine the colon and rectum directly. This is called a sigmoidoscopy or colonoscopy.
[Have you/Has (SP)] ever had this exam?
CCOLSCOP
HFR8A
yes/no
HFR8 - COLSCOPY
Another test for early signs of colon cancer is performed in the doctor's office. The doctor uses a flexible
lighted tube to examine the colon and rectum directly. This is called a sigmoidoscopy or colonoscopy.
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] ever had this exam?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR9 - WHENSCOP
(02) HFR10 - HEARSCOP BOX HFC7
(8) HFR10 - HEARSCOP BOX HFC7
(9) HFR10 - HEARSCOP BOX HFC7
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFC7
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
WHENSCOP
HEARSCOP
COLDRREC
HFR9
code 1
When did [you/(SP)] have [your/his/her] most recent sigmoidoscopy or colonoscopy?
BOX HFC7
routing
IF P_HEARSCOP=YES, GO TO BOX HFR2.
ELSE GO TO HFR10-HEARSCOP.
HFR10
yes/no
Before today, had you ever heard of a sigmoidoscopy or colonoscopy?
BOX HFR2
routing
IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 - COLSCRNS.
ELSE GO TO BOX HFS1.
HFR11
yes/no
Has a doctor or other health professional ever recommended that [you/(SP)] have this test?
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
HFR13 - COLSCRNS
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR11 - COLDRREC
(02) BOX HFR2
(-8) BOX HFR2
(-9) BOX HFR2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFR13 - COLSCRNS
2020 MCBS Community Questionnaire
COLSCRNS
OSTINTRO
OSTEVERT
OSTHRISK
OSTFRACT
OSTTEST
HFR13
HFQ - HEALTH STATUS AND FUNCTIONING
OSTHEAR
BOX HFS1
yes/no
Before today, did you know that Medicare now pays the cost of screening tests for colorectal cancer?
BOX HFS1
routing
IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT ROUND OR IN A PREVIOUS
ROUND (OCOSTEOP=1 or sample_person.P_OCOSTEOP-=1 GO TO HFS3 - OSTTEST BOX HFC8.
ELSE GO TO HFSINTRO - OSTINTRO.
HFSINTRO
no entry
Now I'd like to talk about a disease called osteoporosis, which can be treated if found early. In osteoporosis,
the bones lose their calcium and become fragile and more easily broken.
(01) CONTINUE
(-7) Empty
HFS1 - OSTEVERT
yes/no
[Have you/Has (SP)] ever talked with [your/his/her] doctor or other health professional about osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS2 - OSTHRISK
(02) HFS3 - OSTTEST BOX HFC8
(-8) HFS3 - OSTTEST BOX HFC8
(-9) HFS3 - OSTTEST BOX HFC8
yes/no
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFS2A - OSTFRACT
HFS2A
yes/no
Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health professional told
[you/him/her] was related to osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFS3 - OSTTEST
BOX HFC8
BOX HFC8
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS5 - OSTRECNT
(02) HFS4 - OSTHEAR BOX HFC9
(-8) HFS4 - OSTHEAR BOX HFC9
(-9) HFS4 - OSTHEAR BOX HFC9
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS6 - OSTMASS
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS6 - OSTMASS
(02) HFAC29 - HCTROUBL
(-8) HFAC29 - HCTROUBL
(-9) HFAC29 - HCTROUBL
HFS1
HFS2
HFS3
yes/no
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFS3-OSTTEST.
ELSE GO TO HFS3A-COSTTEST.
There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?
COSTTEST
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFS3A
yes/no
BOX HFC9
routing
HFS4
yes/no
There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] ever had a Bone Mass or Bone Density
Measurement test?
IF P_OSTHEAR=YES, GO TO HFS6 - OSTMASS.
ELSE GO TO HFS4-OSTHEAR.
Before today, had you ever heard of this test?
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
OSTRECNT
OSTMASS
HFS5
HFS6
code 1
yes/no
When was the most recent time that [you/(SP)] had a Bone Mass or Bone Density Measurement test?
Before today, did you know that Medicare would pay for Bone Mass or Bone Density Measurement tests for
Medicare beneficiaries who are at risk for osteoporosis?
Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.
HCTROUBL
HFAC29
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/he/she]
wanted or needed?
Why was that?
HCTCODE
HFAC30A
code all
HCTOTHOS
HFAC30A
verbatim text
OTHER (SPECIFY)
BOX HFF6
routing
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare OR
10/DifficultyGettingAppt, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
HFS6 - OSTMASS
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFAC29 - HCTROUBL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30A - HCTCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
(03) SERVICES/SUPPLIES NOT COVERED
(04) NEEDED TRANSPORTATION TO
DOCTOR/HOSPITAL
(05) DIFFICULTY GETTING HOME HEALTH CARE
(06) NO TREATMENT AVAILABLE/DOCTOR
WON’T TREAT
(07) WAIT TOO LONG/DOCTOR TOO BUSY
(08) OWN DOCTOR DOESN’T ACCEPT
MEDICARE/COULDN’T FIND DOCTOR WHO
ACCEPTS MEDICARE
(09) NOT ELIGIBLE FOR PUBLIC COVERAGE
(10) DIFFICULTY GETTING APPOINTMENT/
DELAYS BECAUSE SP ON MEDICARE
(11) DOCTOR REFERRED SP TO SPECIALIST OR
OTHER DOCTOR
(12) HMO REFERRAL PROCESS (DIFFICULTY
GETTING)
(13) PROBLEMS WITH HMO DOCTORS NOT
GOOD OR AVAILABLE
(14) HMO WOULD NOT COVER OR PROVIDE
SERVICE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX HFF6
(02) BOX HFF6
(03) BOX HFF6
(04) BOX HFF6
(05) BOX HFF6
(06) BOX HFF6
(07) BOX HFF6
(08) BOX HFF6
(09) BOX HFF6
(10) BOX HFF6
(11) BOX HFF6
(12) BOX HFF6
(13) BOX HFF6
(14) BOX HFF6
(91) HFAC30A - HCTOTHOS
(-8) BOX HFF6
(-9) BOX HFF6
(01) [Continuous answer.]
BOX HFF6
2020 MCBS Community Questionnaire
CGETAPPT
HFAC30B
HFQ - HEALTH STATUS AND FUNCTIONING
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they cannot
schedule an appointment with [you/(SP)]?
What were the reasons the doctor’s office offered as an explanation for not scheduling an appointment with
[you/(SP)]?
CGETCODE
HFAC30C
code all
CGETOTOS
CGETOTOS
verbatim text
Please specify the other reason.
BOX HFF7
routing
IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR
7/DocNotAcceptMCAR, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.
[PROBE: Any other reason?]
CHECK ALL THAT APPLY
OFFEXPLN
HFAC30D
yes/no
Did the doctor’s office explain why [it is difficult for Medicare patients to get an appointment/Medicare is not
accepted] at that practice?
OFFEXVB
HFAC30E
verbatim text
What was that explanation?
RECORD VERBATIM.
HCDELAY
HFAC31
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because (you were/he
was/she was) worried about the cost?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30C - CGETCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) DOCTOR DOES NOT ACCEPT INSURANCE
PLAN
(02) ALL OF DOCTORS APPOINTMENTS WERE
FULL
(03) DOCTOR IS NOT ACCEPTING ANY NEW
PATIENTS
(04) DOCTOR IS NOT ACCEPTING NEW
MEDICARE PATIENTS
(05) DOCTORS HOURS CONFLICTED WITH
REQUIREMENTS OF SP
(06) DOCTOR DOES NOT ACCEPT MEDICAID
(07) DOCTOR DOES NOT ACCEPT MEDICARE AT
ALL
(08) DOCTOR DOES NOT ACCEPT MEDICARE
ASSIGNMENT
(09) DOCTOR FELT ANOTHER PROVIDER
WOULD BE BETTER FOR SP
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX HFF7
(02) BOX HFF7
(03) BOX HFF7
(04) BOX HFF7
(05) BOX HFF7
(06) BOX HFF7
(07) BOX HFF7
(08) BOX HFF7
(09) BOX HFF7
(91) HFAC30C - CGETOTOS
(-8) BOX HFF7
(-9) BOX HFF7
(01) [Continuous answer.]
BOX HFF7
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30E - OFFEXVB
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) [Continuous answer.]
HFAC31 - HCDELAY
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
PAYPROB
HFAC32A
yes/no
Since (LAST HF MONTH YEAR) [have you/has (SP)] had problems paying or were unable to pay any
medical bills?
COLLAGNCY
HFAC32
yes/no
Because of problems paying medical bills since (LAST HF MONTH YEAR), [have you/has (SP)] been
contacted by a collection agency?
PAYOVRTM
HFAC32B
yes/no
[Do you /Does (SP)] currently have any medical bills that are being paid off over time?
IADLINTRO
HFKINTRO
no entry
Health problems can include physical, mental, emotional, or memory problems. I'd now like to ask you about
(01) CONTINUE
how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to
(-7) Empty
know whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself].
PRBTELE
HFKA1
code 1
DONTTELE
HFKA2
yes/no
PRBLHWK
HFKB1
code 1
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
using the telephone?
[You said that using the telephone is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
doing light housework (like washing dishes, straightening up, or light cleaning)?
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
HFAC32 A-PAYPROB
(01) HFAC32 - COLLAGNCY
(02) HFKINTRO - IADLINTRO
(-8) HFKINTRO - IADLINTRO
(-9) HFKINTRO - IADLINTRO
HFAC32B- PAYOVRTM
HFKINTRO - IADLINTRO
HFKA1 - PRBTELE
(01) HFKB1 - PRBLHWK
(02) HFKB1 - PRBLHWK
(03) HFKA2 - DONTTELE
(-8) HFKB1 - PRBLHWK
(-9) HFKB1 - PRBLHWK
HFKB1 - PRBLHWK
(01) HFKC1 - PRBHHWK
(02) HFKC1 - PRBHHWK
(03) HFKB2 - DONTLHWK
(-8) HFKC1 - PRBHHWK
(-9) HFKC1 - PRBHHWK
2020 MCBS Community Questionnaire
DONTLHWK
HFKB2
HFQ - HEALTH STATUS AND FUNCTIONING
yes/no
[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something
that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
PRBHHWK
DONTHHWK
HFKC1
HFKC2
code 1
yes/no
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
doing heavy housework (like scrubbing floors or washing windows)?
[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
PRBMEAL
HFKD1
code 1
DONTMEAL
HFKD2
yes/no
PRBSHOP
DONTSHOP
HFKE1
HFKE2
code 1
yes/no
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
preparing [your/his/her] own meals?
[You said that preparing [your/his/her] own meals is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
shopping for personal items (such as toilet items or medicines)?
[You said that shopping for personal items (such as toilet items or medicines) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
PRBBILS
DONTBILS
HFKF1
HFKF2
code 1
yes/no
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
managing money (like keeping track of expenses or paying bills)?
[You said that managing money (like keeping track of expenses or paying bills) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
BOX HFKA1
routing
HFKA3
yes/no
HFKE1 - PRBSHOP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKA4 - PERSON_HLPRTELE
(02) BOX HFKB1
(-8) BOX HFKB1
(-9) BOX HFKB1
HFKC1 - PRBHHWK
(01) HFKD1 - PRBMEAL
(02) HFKD1 - PRBMEAL
(03) HFKC2 - DONTHHWK
(-8) HFKD1 - PRBMEAL
(-9) HFKD1 - PRBMEAL
HFKD1 - PRBMEAL
(01) HFKE1 - PRBSHOP
(02) HFKE1 - PRBSHOP
(03) HFKD2 - DONTMEAL
(-8) HFKE1 - PRBSHOP
(-9) HFKE1 - PRBSHOP
(01) HFKF1 - PRBBILS
(02) HFKF1 - PRBBILS
(03) HFKE2 - DONTSHOP
(-8) HFKF1 - PRBBILS
(-9) HFKF1 - PRBBILS
HFKF1 - PRBBILS
(01) BOX HFKA1
(02) BOX HFKA1
(03) HFKF2 - DONTBILS
(-8) BOX HFKA1
(-9) BOX HFKA1
BOX HFKA1
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 - HELPTELE.
ELSE GO TO BOX HFKB1.
[[You said that [your/(SP's)] health makes using the telephone difficult./You said that using the telephone is
something that [you don't do/(SP) doesn't do].]]
HELPTELE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] receive help from another person with...
using the telephone?
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRTELE = (N+1), GO
TO HFKA4_NEW-ROSTFNAM,
ELSE GO TO BOX HFKB1
PERSON_HLPRTELE
HFKA4
roster
You mentioned that [you receive/(SP) receives] help with using the telephone. Who gives that help?
ENTER ALL HELPERS.
ROSTFNAM
HFKA4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKA4_NEW - ROSTLNAM
ROSTLNAM
HFKA4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKA4_NEW - ROSTREL
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFKA4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKA4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKB1
routing
HELPLHWK
HFKB3
yes/no
IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 - HELPLHWK.
ELSE GO TO BOX HFKC1.
[[You said that [your/(SP's)] health makes doing light housework (like washing dishes, straightening up, or
light cleaning) difficult./You said that doing light housework (like washing dishes, straightening up, or light
cleaning) is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
doing light housework (like washing dishes, straightening up, or light cleaning)?
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKB1
(03) BOX HFKB1
(04) BOX HFKB1
(05) BOX HFKB1
(06) BOX HFKB1
(07) BOX HFKB1
(08) BOX HFKB1
(09) BOX HFKB1
(10) BOX HFKB1
(11) BOX HFKB1
(12) BOX HFKB1
(13) BOX HFKB1
(14) BOX HFKB1
(50) DO NOT DISPLAY
(51) BOX HFKB1
(52) BOX HFKB1
(53) BOX HFKB1
(54) BOX HFKB1
(55) BOX HFKB1
(56) BOX HFKB1
(57) BOX HFKB1
(91) HFKA4_NEW - ROSTREOS
(-8) BOX HFKB1
(-9) BOX HFKB1
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
BOX HFKB1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKB4 - PERSON_HLPRLHWK
(02) BOX HFKC1
(-8) BOX HFKC1
(-9) BOX HFKC1
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRLHWK = (N+1), GO
TO HFKB4_NEW-ROSTFNAM,
ELSE GO TO BOX HFKC1
PERSON_HLPRLHWK
HFKB4
roster
You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes,
straightening up, or light cleaning). Who gives that help?
ROSTFNAM
HFKB4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKB4_NEW - ROSTLNAM
ROSTLNAM
HFKB4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKB4_NEW - ROSTREL
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFKB4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKB4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKC1
routing
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1
HELPHHWK
HFKC3
yes/no
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
[[You said that [your/(SP's)] health makes doing heavy housework (like scrubbing floors or washing windows)
difficult./You said that heavy housework (like scrubbing floors or washing windows) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKC1
(03) BOX HFKC1
(04) BOX HFKC1
(05) BOX HFKC1
(06) BOX HFKC1
(07) BOX HFKC1
(08) BOX HFKC1
(09) BOX HFKC1
(10) BOX HFKC1
(11) BOX HFKC1
(12) BOX HFKC1
(13) BOX HFKC1
(14) BOX HFKC1
(50) DO NOT DISPLAY
(51) BOX HFKC1
(52) BOX HFKC1
(53) BOX HFKC1
(54) BOX HFKC1
(55) BOX HFKC1
(56) BOX HFKC1
(57) BOX HFKC1
(91) HFKB4_NEW - ROSTREOS
(-8) BOX HFKC1
(-9) BOX HFKC1
BOX HFKC1
(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) BOX HFKD1
doing heavy housework (like scrubbing floors or washing windows)?
PERSON_HLPRHHWK
HFKC4
roster
You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or
washing windows). Who gives that help?
ENTER ALL HELPERS.
ROSTFNAM
ROSTLNAM
HFKC4_NEW
HFKC4_NEW
text
text
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
IF PERSON_HLPRHHWK = (N+1), GO
TO HFKC4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKD1.
HFKC4_NEW - ROSTLNAM
HFKC4_NEW - ROSTREL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFKC4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKC4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKD1
routing
HELPMEAL
HFKD3
yes/no
PERSON_HLPRMEAL
HFKD4
roster
ROSTFNAM
ROSTLNAM
HFKD4_NEW
HFKD4_NEW
text
text
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 - HELPMEAL.
ELSE GO TO BOX HFKE1.
[[You said that [your/(SP's)] health makes preparing [your/his/her] own meals difficult./You said that preparing
[your/his/her] own meals is something that [you don't do/(SP) doesn't do].]]
(01) YES
(02) NO
[Do you/Does (SP)] receive help from another person with...
(-8) Don't Know
(-9) Refused
preparing [your/his/her] own meals?
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
You mentioned that [you receive/(SP) receives] help with preparing [your/his/her] own meals. Who gives that (N+1) ADD ANOTHER
help?
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
(01) DO NOT DISPLAY
(02) BOX HFKD1
(03) BOX HFKD1
(04) BOX HFKD1
(05) BOX HFKD1
(06) BOX HFKD1
(07) BOX HFKD1
(08) BOX HFKD1
(09) BOX HFKD1
(10) BOX HFKD1
(11) BOX HFKD1
(12) BOX HFKD1
(13) BOX HFKD1
(14) BOX HFKD1
(50) DO NOT DISPLAY
(51) BOX HFKD1
(52) BOX HFKD1
(53) BOX HFKD1
(54) BOX HFKD1
(55) BOX HFKD1
(56) BOX HFKD1
(57) BOX HFKD1
(91) HFKC4_NEW - ROSTREOS
(-8) BOX HFKD1
(-9) BOX HFKD1
BOX HFKD1
(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) BOX HFKE1
IF PERSON_HLPRMEAL = (N+1), GO
TO HFKD4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKE1.
HFKD4_NEW - ROSTLNAM
HFKD4_NEW - ROSTREL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFKD4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKD4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKE1
routing
HELPSHOP
HFKE3
yes/no
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 - HELPSHOP.
ELSE GO TO BOX HFKF1.
[[You said that [your/(SP's)] health makes shopping for personal items (such as toilet items or medicines)
difficult./You said that shopping for personal items (such as toilet items or medicines) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKE1
(03) BOX HFKE1
(04) BOX HFKE1
(05) BOX HFKE1
(06) BOX HFKE1
(07) BOX HFKE1
(08) BOX HFKE1
(09) BOX HFKE1
(10) BOX HFKE1
(11) BOX HFKE1
(12) BOX HFKE1
(13) BOX HFKE1
(14) BOX HFKE1
(50) DO NOT DISPLAY
(51) BOX HFKE1
(52) BOX HFKE1
(53) BOX HFKE1
(54) BOX HFKE1
(55) BOX HFKE1
(56) BOX HFKE1
(57) BOX HFKE1
(91) HFKD4_NEW - ROSTREOS
(-8) BOX HFKE1
(-9) BOX HFKE1
BOX HFKE1
(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) BOX HFKF1
shopping for personal items (such as toilet items or medicines)?
PERSON_HLPRSHOP
HFKE4
roster
ROSTFNAM
ROSTLNAM
HFKE4_NEW
HFKE4_NEW
text
text
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
You mentioned that [you receive/(SP) receives] help with shopping for personal items (such as toilet items or (N+1) ADD ANOTHER
medicines). Who gives that help?
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
IF PERSON_HLPRSHOP = (N+1), GO
TO HFKE4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKF1.
HFKE4_NEW - ROSTLNAM
HFKE4_NEW - ROSTREL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFKE4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKE4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKF1
routing
HELPBILS
HFKF3
yes/no
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 - HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.
[[You said that [your/(SP's)] health makes managing money (like keeping track of expenses or paying bills)
difficult./You said that managing money (like keeping track of expenses or paying bills) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKF1
(03) BOX HFKF1
(04) BOX HFKF1
(05) BOX HFKF1
(06) BOX HFKF1
(07) BOX HFKF1
(08) BOX HFKF1
(09) BOX HFKF1
(10) BOX HFKF1
(11) BOX HFKF1
(12) BOX HFKF1
(13) BOX HFKF1
(14) BOX HFKF1
(50) DO NOT DISPLAY
(51) BOX HFKF1
(52) BOX HFKF1
(53) BOX HFKF1
(54) BOX HFKF1
(55) BOX HFKF1
(56) BOX HFKF1
(57) BOX HFKF1
(91) HFKE4_NEW - ROSTREOS
(-8) BOX HFKF1
(-9) BOX HFKF1
BOX HFKF1
(01) HFKF4 - PERSON_HLPRBILS
(02) HFLINTRO - ADLSINTRO
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
managing money (like keeping track of expenses or paying bills)?
PERSON_HLPRBILS
HFKF4
roster
ROSTFNAM
ROSTLNAM
HFKF4_NEW
HFKF4_NEW
text
text
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
You mentioned that [you receive/(SP) receives] help with managing money (like keeping track of expenses or (N+1) ADD ANOTHER
paying bills). Who gives that help?
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
IF PERSON_HLPRBILS = (N+1), GO
TO HFKF4_NEW-ROSTFNAM.
ELSE GO TO HFLINTRO ADLSINTRO.
HFKF4_NEW - ROSTLNAM
HFKF4_NEW - ROSTREL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFKF4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKF4_NEW
text
[What is the name of the person and relationship to (SP)?]
no entry
Remembering that health problems can include physical, mental, emotional, or memory problems, I'd now
like to ask you about how health problems may affect [your/(SP)'s] ability to perform some other everyday
activities. I’d like to know whether [you have/(SP) has] any difficulty doing each activity by
[yourself/himself/herself] and without special equipment.
ADLSINTRO
HFLINTRO
HPPDBATH
HFLA1
code 1
DONTBATH
HFLA2
yes/no
HPPDDRES
HFLB1
code 1
DONTDRES
HFLB2
yes/no
HPPDEAT
HFLC1
code 1
DONTEAT
HFLC2
yes/no
HPPDCHAR
DONTCHAR
HFLD1
HFLD2
code 1
yes/no
HPPDWALK
HFLE1
code 1
DONTWALK
HFLE2
code 1
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
bathing or showering?
[You said that bathing or showering is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
dressing?
[You said that dressing is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
eating?
[You said that eating is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
getting in or out of bed or chairs?
[You said that getting in or out of bed or chairs is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
walking?
[You said that walking is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) HFLINTRO - ADLSINTRO
(03) HFLINTRO - ADLSINTRO
(04) HFLINTRO - ADLSINTRO
(05) HFLINTRO - ADLSINTRO
(06) HFLINTRO - ADLSINTRO
(07) HFLINTRO - ADLSINTRO
(08) HFLINTRO - ADLSINTRO
(09) HFLINTRO - ADLSINTRO
(10) HFLINTRO - ADLSINTRO
(11) HFLINTRO - ADLSINTRO
(12) HFLINTRO - ADLSINTRO
(13) HFLINTRO - ADLSINTRO
(14) HFLINTRO - ADLSINTRO
(50) DO NOT DISPLAY
(51) HFLINTRO - ADLSINTRO
(52) HFLINTRO - ADLSINTRO
(53) HFLINTRO - ADLSINTRO
(54) HFLINTRO - ADLSINTRO
(55) HFLINTRO - ADLSINTRO
(56) HFLINTRO - ADLSINTRO
(57) HFLINTRO - ADLSINTRO
(91) HFKF4_NEW - ROSTREOS
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
HFLINTRO - ADLSINTRO
(01) CONTINUE
(-7) Empty
HFLA1 - HPPDBATH
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLB1 - HPPDDRES
(02) HFLB1 - HPPDDRES
(03) HFLA2 - DONTBATH
(-8) HFLB1 - HPPDDRES
(-9) HFLB1 - HPPDDRES
HFLB1 - HPPDDRES
(01) HFLC1 - HPPDEAT
(02) HFLC1 - HPPDEAT
(03) HFLB2 - DONTDRES
(-8) HFLC1 - HPPDEAT
(-9) HFLC1 - HPPDEAT
HFLC1 - HPPDEAT
(01) HFLD1 - HPPDCHAR
(02) HFLD1 - HPPDCHAR
(03) HFLC2 - DONTEAT
(-8) HFLD1 - HPPDCHAR
(-9) HFLD1 - HPPDCHAR
HFLD1 - HPPDCHAR
(01) HFLE1 - HPPDWALK
(02) HFLE1 - HPPDWALK
(03) HFLD2 - DONTCHAR
(-8) HFLE1 - HPPDWALK
(-9) HFLE1 - HPPDWALK
HFLE1 - HPPDWALK
(01) HFLF1 - HPPDTOIL
(02) HFLF1 - HPPDTOIL
(03) HFLE2 - DONTWALK
(-8) HFLF1 - HPPDTOIL
(-9) HFLF1 - HPPDTOIL
HFLF1 - HPPDTOIL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
HPPDTOIL
HFLF1
code 1
DONTTOIL
HFLF2
yes/no
BOX HFLA1
routing
HELPBATH
HFLA3
yes/no
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFLA1
(02) BOX HFLA1
(03) HFLF2 - DONTTOIL
(-8) BOX HFLA1
(-9) BOX HFLA1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLA5 - EQIPBATH
(02) HFLA4 - PCHKBATH
(-8) HFLA4 - PCHKBATH
(-9) HFLA4 - PCHKBATH
HFLA5 - EQIPBATH
How long [have you/has (SP)] needed help with bathing or showering? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLA7 - STILBATH
(02) BOX HFLB1
(03) BOX HFLB1
(-8) BOX HFLB1
(-9) BOX HFLB1
Do you expect that [you/(SP)] will still need help with bathing or showering three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLB1
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
using the toilet, including getting up and down?
[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 - HELPBATH.
ELSE GO TO BOX HFLB1.
[[You said [your/(SP's)] health makes bathing or showering difficult./You said that bathing or showering is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or showering?
Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or showering?
PCHKBATH
HFLA4
yes/no
EQIPBATH
HFLA5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with bathing or showering?
BOX HFLA2
routing
IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.
LONGBATH
STILBATH
HELPDRES
HFLA6
code 1
HFLA7
yes/no
BOX HFLB1
routing
HFLB3
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 - HELPDRES.
ELSE GO TO BOX HFLC1.
[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP)
doesn't] do.]]
(01) HFLB5 - EQIPDRES
(02) HFLB4 - PCHKDRES
(-8) HFLB4 - PCHKDRES
(-9) HFLB4 - PCHKDRES
How long [have you/has (SP)] needed help with dressing? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLB7 - STILDRES
(02) BOX HFLC1
(03) BOX HFLC1
(-8) BOX HFLC1
(-9) BOX HFLC1
Do you expect that [you/(SP)] will still need help with dressing three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLC1
Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
PCHKDRES
HFLB4
yes/no
EQIPDRES
HFLB5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with dressing?
BOX HFLB2
routing
IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.
STILDRES
HELPEAT
HFLB6
code 1
HFLB7
yes/no
BOX HFLC1
routing
HFLC3
yes/no
BOX HFLA2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] receive help from another person with dressing?
LONGDRES
BOX HFLA1
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.
[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with eating?
Does someone usually stay nearby just in case [you need/(SP) needs] help with eating?
PCHKEAT
HFLC4
yes/no
EQIPEAT
HFLC5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with eating?
BOX HFLC2
routing
IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLB5 - EQIPDRES
BOX HFLB2
(01) HFLC5 - EQIPEAT
(02) HFLC4 - PCHKEAT
(-8) HFLC4 - PCHKEAT
(-9) HFLC4 - PCHKEAT
HFLC5 - EQIPEAT
BOX HFLC2
2020 MCBS Community Questionnaire
LONGEAT
STILEAT
HELPCHAR
PCHKCHAR
HFLC6
HFQ - HEALTH STATUS AND FUNCTIONING
code 1
How long [have you/has (SP)] needed help with eating? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLC7 - STILEAT
(02) BOX HFLD1
(03) BOX HFLD1
(-8) BOX HFLD1
(-9) BOX HFLD1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLD1
HFLC7
yes/no
Do you expect that [you/(SP)] will still need help with eating three months from now?
BOX HFLD1
routing
IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 - HELPCHAR.
ELSE GO TO BOX HFLE1.
yes/no
[[You said [your/(SP's)] health makes getting in or out of bed or chairs difficult./You said that getting in or out (01) YES
of bed or chairs is something [you don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?
(-9) Refused
HFLD3
HFLD4
yes/no
Does someone usually stay nearby just in case [you need/(SP) needs] help with getting in or out of bed or
chairs?
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
EQIPCHAR
LONGCHAR
STILCHAR
HELPWALK
HFLD5
yes/no
BOX HFLD2
routing
HFLD6
code 1
(01) YES
(02) NO
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with getting in or out of bed or chairs?
(-8) Don't Know
(-9) Refused
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.
How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . .
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLE1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLE5 - EQIPWALK
(02) HFLE4 - PCHKWALK
(-8) HFLE4 - PCHKWALK
(-9) HFLE4 - PCHKWALK
Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three months from
now?
BOX HFLE1
routing
IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.
[[You said [your/(SP's)] health makes walking difficult./You said that walking is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with walking?
Does someone usually stay nearby just in case [you need/(SP) needs] help with walking?
PCHKWALK
HFLE4
yes/no
EQIPWALK
HFLE5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with walking?
BOX HFLE2
routing
IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.
LONGWALK
HFLE6
code 1
BOX HFLD2
(01) HFLD7 - STILCHAR
(02) BOX HFLE1
(03) BOX HFLE1
(-8) BOX HFLE1
(-9) BOX HFLE1
yes/no
yes/no
HFLD5 - EQIPCHAR
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
HFLD7
HFLE3
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLD5 - EQIPCHAR
(02) HFLD4 - PCHKCHAR
(-8) HFLD4 - PCHKCHAR
(-9) HFLD4 - PCHKCHAR
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
How long [have you/has (SP)] needed help with walking? Has it been . . .
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
HFLE5 - EQIPWALK
BOX HFLE2
(01) HFLE7 - STILWALK
(02) BOX HFLF1
(03) BOX HFLF1
(-8) BOX HFLF1
(-9) BOX HFLF1
2020 MCBS Community Questionnaire
STILWALK
HELPTOIL
HFQ - HEALTH STATUS AND FUNCTIONING
HFLE7
yes/no
Do you expect that [you/(SP)] will still need help with walking three months from now?
BOX HFLF1
routing
IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 - HELPTOIL.
ELSE GO TO BOX HFLA3.
yes/no
[[You said [your/(SP's)] health makes using the toilet difficult./You said that using the toilet is something [you (01) YES
don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with using the toilet, including getting up and down?
(-9) Refused
HFLF3
PCHKTOIL
HFLF4
yes/no
EQIPTOIL
HFLF5
yes/no
BOX HFLF2
routing
LONGTOIL
STILTOIL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLF6
code 1
Does someone usually stay nearby just in case [you need/(SP) needs] help with using the toilet, including
getting up and down?
(01) YES
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-9) Refused
(01) YES
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet, including getting (02) NO
up and down?
(-8) Don't Know
(-9) Refused
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLA3
BOX HFLA3
routing
IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.
ROSTFNAM
ROSTLNAM
HFLA9_NEW
HFLA9_NEW
text
text
BOX HFLF2
How long [have you/has (SP)] needed help with using the toilet? Has it been . . .
Do you expect that [you/(SP)] will still need help with using the toilet three months from now?
roster
HFLF5 - EQIPTOIL
(01) HFLF7 - STILTOIL
(02) BOX HFLA3
(03) BOX HFLA3
(-8) BOX HFLA3
(-9) BOX HFLA3
yes/no
HFLA9
(01) HFLF5 - EQIPTOIL
(02) HFLF4 - PCHKTOIL
(-8) HFLF4 - PCHKTOIL
(-9) HFLF4 - PCHKTOIL
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
HFLF7
PERSON_HLPRBATH
BOX HFLF1
You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
ROSTREL
HFLA9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLA9_NEW
text
[What is the name of the person and relationship to (SP)?]
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
IF PERSON_HLPRBATH = (N+1) , GO
TO HFLA9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLB3.
HFLA9_NEW - ROSTLNAM
HFLA9_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) BOX HFLB3
(03) BOX HFLB3
(04) BOX HFLB3
(05) BOX HFLB3
(06) BOX HFLB3
(07) BOX HFLB3
(08) BOX HFLB3
(09) BOX HFLB3
(10) BOX HFLB3
(11) BOX HFLB3
(12) BOX HFLB3
(13) BOX HFLB3
(14) BOX HFLB3
(50) DO NOT DISPLAY
(51) BOX HFLB3
(52) BOX HFLB3
(53) BOX HFLB3
(54) BOX HFLB3
(55) BOX HFLB3
(56) BOX HFLB3
(57) BOX HFLB3
(91) HFLA9_NEW - ROSTREOS
(-8) BOX HFLB3
(-9) BOX HFLB3
BOX HFLB3
2020 MCBS Community Questionnaire
BOX HFLB3
HFQ - HEALTH STATUS AND FUNCTIONING
routing
PERSON_HLPRDRES
HFLB9
roster
ROSTFNAM
ROSTLNAM
HFLB9_NEW
HFLB9_NEW
text
text
IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.
You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
ROSTREL
HFLB9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLB9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLC3
routing
IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.
PERSON_HLPREAT
HFLC9
roster
ROSTFNAM
ROSTLNAM
HFLC9_NEW
HFLC9_NEW
text
text
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
IF PERSON_HLPRBATH = (N+1), GO
TO HFLB9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLC3.
HFLB9_NEW - ROSTLNAM
HFLB9_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) BOX HFLC3
(03) BOX HFLC3
(04) BOX HFLC3
(05) BOX HFLC3
(06) BOX HFLC3
(07) BOX HFLC3
(08) BOX HFLC3
(09) BOX HFLC3
(10) BOX HFLC3
(11) BOX HFLC3
(12) BOX HFLC3
(13) BOX HFLC3
(14) BOX HFLC3
(50) DO NOT DISPLAY
(51) BOX HFLC3
(52) BOX HFLC3
(53) BOX HFLC3
(54) BOX HFLC3
(55) BOX HFLC3
(56) BOX HFLC3
(57) BOX HFLC3
(91) HFLB9_NEW - ROSTREOS
(-8) BOX HFLC3
(-9) BOX HFLC3
BOX HFLC3
IF PERSON_HLPREAT = (N+1) GO TO
HFLC9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLD3.
HFLC9_NEW - ROSTLNAM
HFLC9_NEW - ROSTREL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFLC9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLC9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLD3
routing
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.
PERSON_HLPRCHAR
HFLD9
roster
You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that
help?
ENTER ALL HELPERS.
ROSTFNAM
ROSTLNAM
HFLD9_NEW
HFLD9_NEW
text
text
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
ROSTREL
HFLD9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLD9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLE3
routing
IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLD3
(03) BOX HFLD3
(04) BOX HFLD3
(05) BOX HFLD3
(06) BOX HFLD3
(07) BOX HFLD3
(08) BOX HFLD3
(09) BOX HFLD3
(10) BOX HFLD3
(11) BOX HFLD3
(12) BOX HFLD3
(13) BOX HFLD3
(14) BOX HFLD3
(50) DO NOT DISPLAY
(51) BOX HFLD3
(52) BOX HFLD3
(53) BOX HFLD3
(54) BOX HFLD3
(55) BOX HFLD3
(56) BOX HFLD3
(57) BOX HFLD3
(91) HFLC9_NEW - ROSTREOS
(-8) BOX HFLD3
(-9) BOX HFLD3
BOX HFLD3
IF PERSON_HLPRCHAR = (N+1) , GO
TO HFLD9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLE3.
HFLD9_NEW - ROSTLNAM
HFLD9_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) BOX HFLE3
(03) BOX HFLE3
(04) BOX HFLE3
(05) BOX HFLE3
(06) BOX HFLE3
(07) BOX HFLE3
(08) BOX HFLE3
(09) BOX HFLE3
(10) BOX HFLE3
(11) BOX HFLE3
(12) BOX HFLE3
(13) BOX HFLE3
(14) BOX HFLE3
(50) DO NOT DISPLAY
(51) BOX HFLE3
(52) BOX HFLE3
(53) BOX HFLE3
(54) BOX HFLE3
(55) BOX HFLE3
(56) BOX HFLE3
(57) BOX HFLE3
(91) HFLD9_NEW - ROSTREOS
(-8) BOX HFLE3
(-9) BOX HFLE3
BOX HFLE3
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
PERSON_HLPRWALK
HFLE9
roster
ROSTFNAM
ROSTLNAM
HFLE9_NEW
HFLE9_NEW
text
text
You mentioned that [you receive/(SP) receives] help with walking. Who gives that help?
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
ROSTREL
HFLE9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLE9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLF3
routing
IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.
PERSON_HLPRTOIL
HFLF9
roster
ROSTFNAM
ROSTLNAM
HFLF9_NEW
HFLF9_NEW
text
text
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with using the toilet. Who gives that help?
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
IF PERSON_HLPRWALK = (N+1), GO
TO HFLE9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLF3.
HFLE9_NEW - ROSTLNAM
HFLE9_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) BOX HFLF3
(03) BOX HFLF3
(04) BOX HFLF3
(05) BOX HFLF3
(06) BOX HFLF3
(07) BOX HFLF3
(08) BOX HFLF3
(09) BOX HFLF3
(10) BOX HFLF3
(11) BOX HFLF3
(12) BOX HFLF3
(13) BOX HFLF3
(14) BOX HFLF3
(50) DO NOT DISPLAY
(51) BOX HFLF3
(52) BOX HFLF3
(53) BOX HFLF3
(54) BOX HFLF3
(55) BOX HFLF3
(56) BOX HFLF3
(57) BOX HFLF3
(91) HFLE9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3
BOX HFLF3
IF PERSON_HLPRTOIL = (N+1), GO
TO HFLF9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLG3.
HFLF9_NEW - ROSTLNAM
HFLF9_NEW - ROSTREL
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ROSTREL
HFLF9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLF9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFL4
routing
IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9, HFLD9, HFLE9, AND/OR HFLF9,
GO TO HFL10 - PERSON_HLPRMOST.
ELSE GO TO HFM1 - FALLANY.
PERSON_HLPRMOST
HFL10
roster
ROSTFNAM
ROSTLNAM
HFL10_NEW
HFL10_NEW
text
text
Which of these persons gives [you/(SP)] the most help with these things?
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE
OPTIONS
(N+1) ADD ANOTHER
SELECT ONLY ONE.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
[What is the name of the person and relationship to (SP)?]
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER
ROSTREL
HFL10_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFL10_NEW
text
[What is the name of the person and relationship to (SP)?]
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLF3
(03) BOX HFLF3
(04) BOX HFLF3
(05) BOX HFLF3
(06) BOX HFLF3
(07) BOX HFLF3
(08) BOX HFLF3
(09) BOX HFLF3
(10) BOX HFLF3
(11) BOX HFLF3
(12) BOX HFLF3
(13) BOX HFLF3
(14) BOX HFLF3
(50) DO NOT DISPLAY
(51) BOX HFLF3
(52) BOX HFLF3
(53) BOX HFLF3
(54) BOX HFLF3
(55) BOX HFLF3
(56) BOX HFLF3
(57) BOX HFLF3
(91) HFLF9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3
BOX HFLF3
IF PERSON_HLPRMOST = (N+1), GO
TO HFLF10_NEW-ROSTFNAM.
ELSE GO TO HFM1 - FALLANY.
HFLF10_NEW - ROSTLNAM
HFLF10_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) HFM1 - FALLANY
(03) HFM1 - FALLANY
(04) HFM1 - FALLANY
(05) HFM1 - FALLANY
(06) HFM1 - FALLANY
(07) HFM1 - FALLANY
(08) HFM1 - FALLANY
(09) HFM1 - FALLANY
(10) HFM1 - FALLANY
(11) HFM1 - FALLANY
(12) HFM1 - FALLANY
(13) HFM1 - FALLANY
(14) HFM1 - FALLANY
(50) DO NOT DISPLAY
(51) HFM1 - FALLANY
(52) HFM1 - FALLANY
(53) HFM1 - FALLANY
(54) HFM1 - FALLANY
(55) HFM1 - FALLANY
(56) HFM1 - FALLANY
(57) HFM1 - FALLANY
(91) HFLF10_NEW - ROSTREOS
(-8) HFM1 - FALLANY
(-9) HFM1 - FALLANY
HFM1 - FALLANY
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
FALLANY
HFM1
yes/no
FALLTIME
HFM2
numeric
FALLHELP
HFM3A
yes/no
FALCODE
HFM3B
code all
FALOTHOS
HFM3B
verbatim text
FALLIMIT
HFM3C
yes/no
FALLBACK
HFM3D
code 1
FALLFEAR
HFM3E
numeric
BOX MH1
routing
HFGAD1
HFN1
list
HFGAD2
HFN2
list
HFPHQ1
HFN3
list
HFPHQ2
HFN4
list
HFPHQ3
HFN5
list
HFPHQ4
HFN6
list
HFPHQ5
HFN7
list
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
(-8) Don't Know
(-9) Refused
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down?
[Continuous answer.]
Don't Know
ENTER "95" IF 95 OR MORE FALLS REPORTED.
Refused
(01) YES
Thinking about the [most recent) time that [you/(SP)] fell, did [you/he/she] hurt [yourself/himself/herself] badly (02) NO
(-8) Don't Know
enough to get medical help?
(-9) Refused
(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
(03) BRUISE
What kind of injury did [you/(SP)] have in that [most recent] fall?
(04) CUT/WOUND/LACERATION
(05) CONCUSSION
[PROBE: Anything else?]
(06) DISLOCATION
(91) OTHER
CHECK ALL THAT APPLY.
(96) NO INJURY
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
(01) [Continuous answer.]
(01) YES
(02) NO
Did [your/(SP's)] [most recent] fall cause [you/him/her] to limit [your/his/her] regular acivities?
(-8) Don't Know
(-9) Refused
(01) LESS THAN ONE WEEK
(02) ONE WEEK OR MORE
How long did it take [you/(SP)] to get back to regular activities after [your/his/her] [most recent] fall?
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is "Not at all afraid of falling" and
(-8) Don't Know
6 is "Extremely afraid of falling"?
(-9) Refused
If the respondent is a proxy (SPPROXY=2), go to HFQ1 - LOSTURIN.
Else go to HFN1 - HFGAD1.
The next few questions ask about the last two weeks.
(01) NOT AT ALL
(02) SEVERAL DAYS
SHOW CARD HF8
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
Over the last 2 weeks, how often have you been bothered by the following problems?
(-8) REFUSED
(-9) DON’T KNOW
Feeling nervous, anxious, or on edge
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems?]
(04) NEARLY EVERY DAY
(-8) REFUSED
Not being able to stop or control worrying.
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
little interest or pleasure in doing things? Would you say…
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling down, depressed, or hopeless?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
trouble falling or staying asleep, or sleeping too much?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling tired or having little energy?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
poor appetite or overeating?
(-9) DON’T KNOW
(01) HFM2 - FALLTIME
(02) BOX MH1
(-8) BOX MH1
(-9) BOX MH1
HFM3A - FALLHELP
HFM3B - FALCODE
(01) HFM3C - FALLIMIT
(02) HFM3C - FALLIMIT
(03) HFM3C - FALLIMIT
(04) HFM3C - FALLIMIT
(05) HFM3C - FALLIMIT
(06) HFM3C - FALLIMIT
(91) HFM3B - FALOTHOS
(96) HFM3C - FALLIMIT
(-8) HFM3C - FALLIMIT
(-9) HFM3C - FALLIMIT
HFM3C - FALLIMIT
(01) HFM3D - FALLBACK
(02) HFM3E - FALLFEAR
(-8) HFM3E - FALLFEAR
(-9) HFM3E - FALLFEAR
HFM3E - FALLFEAR
BOX MH1
HFN2 - HFGAD2
HFN3 - HFPHQ1
HFN4 - HFPHQ2
HFN5 - HFPHQ3
HFN6 - HFPHQ4
HFN7 - HFPHQ5
HFN8 - HFPHQ6
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling bad about yourself – or that you are a failure or have let yourself or your family down?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
trouble concentrating on things, such as reading the newspaper or watching TV?
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or
(-9) DON’T KNOW
restless that you have been moving around a lot more than usual?
(01) Not at all difficult,
(02) Somewhat difficult,
SHOW CARD HF9
(03) Very difficult,
How difficult have these problems made it for you to do your work, take care of things at home, or get along (04) Extremely difficult?
(-8) REFUSED
with people?
(-9) DON’T KNOW
(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
SHOW CARD HF10
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
I'd like to ask about a health problem that is more common than people think. Please look at this card and
(06) ONCE OR TWICE A YEAR
tell me how often, if at all, since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine because
(07) NOT AT ALL
[you/he/she] could not control [your/his/her] bladder.
(08) SP IS ON DIALYSIS OR CATHETERIZATION
OR UROSTOMY OR BLADDER BAG
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other health professional?
(-8) Don't Know
(-9) Refused
(01) YES
Has [your/(SP’s)] doctor or other health professional asked [you/him/her] about how [you/he/she] feel[s] about (02) NO
(-8) Don't Know
this problem?
(-9) Refused
(01) YES
Has [your/(SP’s)] doctor or other health professional examined [you/him/her] to figure out why [you/he/she]
(02) NO
[lose/loses] urine?
(-8) Don't Know
(-9) Refused
(01) YES
Has [your/(SP’s)] doctor or other health professional talked with [you/him/her] about taking medicine or having (02) NO
surgery for this problem?
(-8) Don't Know
(-9) Refused
IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.
We have recorded that [you were/(SP) was] told by a doctor or other health professional that [you had/he
(01) YES
had/she had] hypertension, also called high blood pressure.
(02) NO
(03) SP NEVER HAD HIGH BLOOD
[Were you/Was (SP)] told on two or more different medical visits that [you/he/she] had high blood pressure or
PRESSURE/PREVIOUS RESPONSE ENTERED IN
hypertension?
ERROR
(-8) Don't Know
[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)] blood pressure was high for
(-9) Refused
more than one reading.]
(01) [Continuous answer.]
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had high blood
(-8) Don't Know
pressure?
(-9) Refused
How old [were you/was (SP)] when (you were/he was/she was) first told that [you/he/she] had high blood
(01) LESS THAN ONE YEAR OLD
pressure?
(-7) Empty
(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now measuring [your/his/her] blood pressure (02) NO
(-8) Don't Know
at home?
(-9) Refused
(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now taking prescribed medicine for
(02) NO
[your/his/her] high blood pressure?
(-8) Don't Know
(-9) Refused
(01) YES
[Have you/Has (SP)] cut down on drinking alcoholic beverages because of [your/his/her] high blood
(02) NO
pressure?]
(-8) Don't Know
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.
SHOW CARD HF8
HFPHQ6
HFN8
list
HFPHQ7
HFN9
list
HFPHQ8
HFN10
list
HFPHQ10
HFN11
code one
LOSTURIN
HFQ1
code 1
TALKURIN
HFQ2
yes/no
FEELURIN
HFQ3
yes/no
REASURIN
HFQ4
yes/no
SURGURIN
HFQ5
yes/no
BOX HFT1
routing
HYPETOLD
HFT1
code 1
HYPEAGE
HFT2
numeric
HYPEAGE_LESSONE
HFT2
numeric
HYPEHOME
HFT6D
yes/no
HYPEMEDS
HFT6G
yes/no
HYPEDRNK
HFT6J
yes/no
BOX HFT2
routing
HFN9 - HFPHQ7
HFN10 - HFPHQ8
HFN11 - HFPHQ10
HFQ1 - LOSTURIN
(01) HFQ2 - TALKURIN
(02) HFQ2 - TALKURIN
(03) HFQ2 - TALKURIN
(04) HFQ2 - TALKURIN
(05) HFQ2 - TALKURIN
(06) HFQ2 - TALKURIN
(07) BOX HFT1
(08) BOX HFT1
(-8) BOX HFT1
(-9) BOX HFT1
(01) HFQ3 - FEELURIN
(02) BOX HFT1
(-8) BOX HFT1
(-9) BOX HFT1
HFQ4 - REASURIN
HFQ5 - SURGURIN
BOX HFT1
(01) HFT2 - HYPEAGE
(02) HFT2 - HYPEAGE
(03) BOX HFEND
(-8) HFT2 - HYPEAGE
(-9) HFT2 - HYPEAGE
HFT2 - HYPEAGE_LESSONE
HFT6D - HYPEHOME
HFT6G - HYPEMEDS
HFT6J - HYPEDRNK
BOX HFT2
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
HYPELONG
HFT7
numeric
HYPELONG_LESSONE
HFT7
numeric
BOX HFT3
routing
(01) [Continuous answer.]
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood pressure? (-8) Don't Know
(-9) Refused
(01) LESS THAN ONE YEAR
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood pressure?
(-7) Empty
HYPECOND
HYPECTRL
HFT8
HFT11A
numeric
code 1
HFT12A
code 1
BOX HFT4
routing
HYPEPAY
HFT13
yes/no
HYPESKIP
HFT14
yes/no
BALINTRO
HFQ15
no entry
BOX HFT3
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFT8 - HYPEMANY.
ELSE GO TO HFT11A - HYPECOND.
How many different prescribed medicines [do you/does (SP)] take for [your/his/her] high blood pressure?
HYPEMANY
HFT7 - HYPELONG_LESSONE
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD
PRESSURE ARE TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN
ONE DAY.]
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] have trouble with side effects from [your/his/her] blood pressure medicines[s]? (01) ALWAYS
Please tell me if [you/he/she] always, sometimes, or never [have/has] trouble with side effects.
(02) SOMETIMES
(03) NEVER
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such as
(-8) Don't Know
fatigue, headache, or coughing.]
(-9) Refused
(01) VERY CONFIDENT
Doctors and other health professionals often recommend changing your habits or lifestyle, such as changing
(02) CONFIDENT
your diet, or getting regular exercise in order to control blood pressure. How confident are you that [you/(SP)]
(03) SOMEWHAT CONFIDENT
can follow these recommendation?
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
Would you say that you are very confident, confident, somewhat confident, or not at all confident?
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.
(01) YES
[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/his/her] doctor or other health professional (02) NO
(-8) Don't Know
prescribes for [your/his/her] high blood pressure?
(-9) Refused
(01) YES
[Do you/Does (SP)] ever skip taking [your/his/her] medicine, take less medicine than prescribed, or share
(02) NO
medicine because of the cost of the medicine?
(-8) Don't Know
(-9) Refused
Next I am going to ask you to do a few simple activities for me, starting with a balance measure. Let me first
demonstrate this measure. After I demonstrate the measure, please tell me if you cannot do a particular
movement or if you feel it would be unsafe to try and do it.
(1) CONTINUE
(2) R CANNOT PARTICIPATE
(-9) REFUSED
HFT11A - HYPECOND
HFT12A - HYPECTRL
BOX HFT4
HFT14 - HYPESKIP
BOX HFEND
(1) BALPOS1
(2) WALINTRO
(-9) WALINTRO
SHOWCARD HF11
DEMONSTRATE FIRST POSITION WHILE EXPLAINING POSITION
STAND WITH FEET TOGETHER, SIDE-BY-SIDE FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN FIRST POSITION
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
BALPOS1
HFQ16
code one
TIME THE FIRST POSITION
PUSH ‘START/STOP’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘START/STOP’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘START/STOP’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10
SECONDS
WHEN R IS IN FIRST POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START/STOP’ AND SAY:
Begin
(1) NUMBER OF SECONDS HELD: _____
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT HOLD POSITION UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
If (1) >= 10, go to BALPOS2;
(6) NOT ATTEMPTED, R FELT UNSAFE
ELSE TO TO BALNOTES
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ________________
(-8) DON'T KNOW
(-9) REFUSED
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
SHOWCARD HF12
DEMONSTRATE SECOND POSITION WHILE EXPLAINING POSITION
STAND WITH THE HEEL OF ONE FOOT TOUCHING THE SIDE OF THE BIG TOE OF THE OTHER
FOOT FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN SECOND POSITION
BALPOS2
HFQ17
code one
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
TIME THE SECOND POSITION
PUSH ‘START/STOP’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘START/STOP’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘START/STOP’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10
SECONDS
(1) NUMBER OF SECONDS HELD: _____
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT HOLD POSITION UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
If (1) >= 10, go to BALPOS3;
(6) NOT ATTEMPTED, R FELT UNSAFE
ELSE TO TO BALNOTES
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ________________
(-8) DON'T KNOW
(-9) REFUSED
WHEN R IS IN SECOND POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START/STOP’ AND SAY:
Begin
SHOWCARD HF13
BALPOS3
HFQ18
code one
DEMONSTRATE THIRD POSITION WHILE EXPLAINING POSITION
STAND WITH THE HEEL OF ONE FOOT IN FRONT OF AND TOUCHING THE TOES OF THE OTHER
FOOT FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
(1) NUMBER OF SECONDS HELD: _____
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
ASK R TO STAND IN THIRD POSITION
(4) R COULD NOT HOLD POSITION UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
BALNOTES
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
TIME THE THIRD POSITION
(8) OTHER (SPECIFY): ________________
PUSH ‘START/STOP’ BUTTON WHEN YOU SAY ‘BEGIN’
(-8) DON'T KNOW
PUSH ‘START/STOP’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
(-9) REFUSED
PUSH ‘START/STOP’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10
SECONDS
WHEN R IS IN THIRD POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START/STOP’ AND SAY:
Begin
BALNOTES
WALINTRO
HFQ19
HFQ20
text
ENTER NOTES ABOUT THE BALANCE TEST
(1) CONTINUOUS
WALINTRO
no entry
Now I am going to observe how you normally walk. If you use a cane or other walking aid and you feel you
need it to walk a short distance, then you may use it. First, let me demonstrate this measure.
(1) CONTINUE
(2) R CANNOT PARTICIPATE (IN WHEELCHAIR,
CAN’T STAND UNASSISTED)
(-9) REFUSED
(1) WALKTIM1
(2) WALNOTES
(3) WALNOTES
(1) ABLE TO DO (SPECIFY SECONDS): ______
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT WALK UNASSISTED
(5) NOT ATTEMPTED, FI FELT UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ___________
(-8) DON'T KNOW
(-9) REFUSED
(1) WALKTIM2
(2) WALNOTES
(3) WALNOTES
(4) WALNOTES
(5) WALNOTES
(6) WALNOTES
(7) WALNOTES
(8) WALNOTES
(-8) WALNOTES
(-9) WALNOTES
USE PRE-CUT STRING TO MEASURE DISTANCE ON THE FLOOR
DEMONSTRATE THE WALK WHILE PROVIDING INSTRUCTIONS
STAND WITH TOES TOUCHING THE BEGINNING OF THE STRING
START WALKING WHEN I SAY BEGIN
WALK AT YOUR USUAL PACE
WALK PAST THE END OF THE STRING BEFORE YOU STOP
WALKTIM1
HFQ21
code one
ALLOW R TO USE HIS/HER WALKING AID (CANE OR WALKER)
ASK R TO STAND AT BEGINNING OF STRING
When I say “Begin” you may start walking.
PUSH ‘START/STOP’ AND SAY:
‘Begin’
PUSH ‘START/STOP’ WHEN ONE OF R’S FEET IS COMPLETELY ACROSS THE OTHER END OF THE
STRING
2020 MCBS Community Questionnaire
HFQ - HEALTH STATUS AND FUNCTIONING
ASK RESPONDENT TO REPEAT WALK, FROM THE END OF THE STRING BACK TO THE BEGINNING
OF THE STRING
When I say “Begin” you may start walking.
WALKTIM2
HFQ22
code one
PUSH ‘START/STOP’ AND SAY:
‘Begin’
PUSH ‘START/STOP’ WHEN ONE OF R’S FEET IS COMPLETELY ACROSS THE OTHER END OF THE
STRING
(1) ABLE TO DO (SPECIFY SECONDS): ______
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT WALK UNASSISTED
(5) NOT ATTEMPTED, FI FELT UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ___________
(-8) DON'T KNOW
(-9) REFUSED
(1) WALKPROB
(2) WALKPROB
(3) WALKPROB
(4) WALKPROB
(5) WALKPROB
(6) WALKPROB
(7) WALKPROB
(8) WALKPROB
(-8) WALKPROB
(-9) WALKPROB
WALNOTES
WALKPROB
HFQ23
code all
CHECK ALL THAT APPLY
(1) R WALKED UNSTEADILY
(2) R LIMPED, SHUFFLED OR DRAGGED A LEG
(3) R USED A CANE
(4) R USED WALKER
(5) R STATED IT’S PAINFUL
(6) NOTHING APPLIES
WALNOTES
HFQ24
text
ENTER NOTES ABOUT THE GAIT SPEED TEST
(1) CONTINUOUS
CSINTRO
no entry
Now I am going to ask you to stand up from a chair without using your arms. First, let me demonstrate this
measure. After I demonstrate the measure, please tell me if you cannot do this movement or if you feel it
would be unsafe to try.
(1) CONTINUE
(2) R CANNOT PARTICIPATE (IN WHEELCHAIR,
CAN’T STAND UNASSISTED)
(-9) REFUSED
(1) SNGLCS
(2) CSNOTES
(-9) CSNOTES
(1) R STOOD WITHOUT USING ARMS
(2) R USED ARMS TO STAND
(3) EQUIPMENT PROBLEM
(4) TRIED, UNABLE TO DO
(5) R COULD NOT STAND UNASSISTED
(6) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(7) NOT ATTEMPTED, R FELT UNSAFE
(8) R UNABLE TO UNDERSTAND INSTRUCTIONS
(9) OTHER (SPECIFY): __________
(-8) DON'T KNOW
(-9) REFUSED
(1) CSINTRO2
(2) CSNOTES
(3) CSNOTES
(4) CSNOTES
(5) CSNOTES
(6) CSNOTES
(7) CSNOTES
(8) CSNOTES
(9) CSNOTES
(-8) CSNOTES
(-9) CSNOTES
CSINTRO
SNGLCS
HFQ25
HFQ26
code one
DEMONSTRATE CHAIR STAND WHILE PROVIDING INSTRUCTIONS
SIT IN CHAIR WITH YOUR FEET ON THE FLOOR. SIT SO THAT YOU CAN PLACE THE WIDTH OF
YOUR HANDS BETWEEN THE CHAIR AND YOUR KNEES.
FOLD YOUR ARMS ACROSS YOUR CHEST
STAND UP, KEEPING YOUR ARMS FOLDED ACROSS YOUR CHEST
When I say ‘Begin’ you may stand up straight from the chair.
IF R CANNOT RISE WITHOUT USING ARMS, ASK R TO TRY TO STAND UP USING ARMS
CSINTRO2
HFQ27
no entry
Now I'm going to ask you to stand up and sit down as quickly as you can five times, keeping your arms folded
(1) CONTINUE
across your chest. I'm going to demonstrate one for you.
DEMONSTRATE 1 CHAIR STAND WHILE PROVIDING INSTRUCTIONS
SIT IN CHAIR WITH YOUR FEET ON THE FLOOR
FOLD YOUR ARMS ACROSS YOUR CHEST
STAND UP AND SIT DOWN ONCE
TELL R TO REPEAT THAT 4 MORE TIMES
RPTDCS
HFQ28
code one
When I say “Begin” you may stand up.
PUSH ‘START/STOP’ AND SAY ‘Begin’
COUNT OUT LOUD AS RESPONDENT ARISES EACH TIME
PUSH ‘START/STOP’ WHEN R HAS COMPLETELY STOOD UP FROM THE CHAIR FOR THE 5TH TIME
STOP THE EXERCISE EARLY IF R CANNOT RISE WITHOUT USING ARMS, R IS TOO TIRED TO
CONTINUE, OR R IS UNABLE TO COMPLETE AFTER 1 MINUTE
CSNOTES
HFQ29
text
(1) TIME TO COMPLETE FIVE STANDS (SPECIFY
SECONDS): ______
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT STAND UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): __________
(-8) DON'T KNOW
(-9) REFUSED
ENTER NOTES ABOUT THE CHAIR STAND TEST
RPTDCS
CSNOTES
CNTTM20
Now I'd like to ask you some questions having to do with memory. For this next question, please try to count
backward as quickly as you can from the number I will give you. I will tell you when to stop.
CNTTM20
HFQ30
numeric
ALLOW R TO START OVER IF S/HE WISHES TO DO SO
Please start with: 20
(1) CONTINUOUS
(-8) DON'T KNOW
(-9) REFUSED
(1) CNTOTCM1
(-8) TDYMTH
(-9) TDYMTH
CORRECT RESPONSES INCLUDE COUNTING DOWN FROM 19 TO 10 OR FROM 20 TO 11
You may stop now. Thank you.
CNTOTCM1
HFQ31
code one
CNTTMT2
HFQ32
numeric
(1) CORRECT
(2) INCORRECT
CODE CORRECT IF R COUNTED BACKWARDS FROM 19 TO 10 OR FROM 20 TO 11 WITHOUT ERROR
(3) WANTS TO START OVER
(-9) REFUSED
ALLOW R TO START OVER IF S/HE WISHES TO DO SO
Let's try again.
The number to count backward from is: 20
(1) CONTINUOUS
(-8) DON'T KNOW
(-9) REFUSED
(1) TDYMTH
(2) TDYMTH
(3) CNTTMT2
(-9) TDYMTH
CNTOTCM2
2020 MCBS Community Questionnaire
CNTOTCM2
HFQ33
HFQ - HEALTH STATUS AND FUNCTIONING
code one
You may stop now. Thank you.
(1) CORRECT
(2) INCORRECT
CODE CORRECT IF R COUNTED BACKWARDS FROM 19 TO 10 OR FROM 20 TO 11 WITHOUT ERROR (-9) REFUSED
Please tell me today's date.
TDYMTH
HFQ34
code one
PROBE MONTH, DAY, YEAR, DAY OF WEEK
THE DATE IS: MONTH/DAY/YEAR
Please tell me today's date.
TDYDAY
HFQ35
code one
PROBE MONTH, DAY, YEAR, DAY OF WEEK
THE DATE IS: MONTH/DAY/YEAR
Please tell me today's date.
TDYYEAR
HFQ36
code one
PROBE MONTH, DAY, YEAR, DAY OF WEEK
THE DATE IS: MONTH/DAY/YEAR
What is the day of the week?
TDYDOW
HFQ37
code one
SCISSOR
HFQ38
code one
Now I'm going to ask you for the names of some people and things.
What do people usually use to cut paper?
CACTUS
HFQ39
code one
What do you call the kind of prickly plant that grows in the desert?
THE DAY OF THE WEEK IS: DAY OF WEEK
Who is the President of the United States right now?
POTUS
HFQ40
code one
ANSWER IS TRUMP
PROBE FOR LAST NAME
Who is Vice President?
VPOTUS
HFQ41
code one
ANSWER IS PENCE
PROBE FOR LAST NAME
BOX HFEND
routing
GO TO NAQ.
TDYMTH
(1) MONTH CORRECT
(2) MONTH NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
TDYDAY
(1) DAY OF MONTH CORRECT
(2) DAY OF MONTH NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
TDYYEAR
(1) YEAR CORRECT
(2) YEAR NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
TDYDOW
(1) DAY CORRECT
(2) DAY NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
(1) SCISSORS OR SHEARS
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
(1) CACTUS OR NAME OF KIND OF CACTUS
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
SCISSOR
CACTUS
POTUS
(1) LAST NAME CORRECT
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
VPOTUS
(1) LAST NAME CORRECT
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
HFEND
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |