CMS-P-0015A Use of Health Services

2018 MCBS Facility Instrument

Variable Name

US- Use of Health Services

MR Screen Name Question Type

Question Text/Description

Code List

Routing

(01) CONSENT OBTAINED (CONTINUE INTERVIEW)
(02) FINAL CONSENT DENIED
(03) REFUSAL CONVERTED (CONTINUE INTERVIEW)
(04) FINAL REFUSAL

(01) US1PRE - US1PRECT
(02) USEND - USENDCT
(03) US1PRE - US1PRECT)
(04) USEND - USENDCT

(01) CONTINUE
(02) CONSENT REQUIRED
(03) INITIAL REFUSAL

(01) US1 - OUTMDVST
(02) USEND - USENDCT
(03) USEND - USENDCT

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US3 - INMDVST
(01) US2 - OUTMDFRQ
(-8) US3 - INMDVST
(-9) US3 - INMDVST

USE OF HEALTH SERVICES SECTION SPECIFICATIONS
CRITERIA
SAMPLE TYPE= CFR, CFC, FFC, FCF
SEASON= ALL
PLACEMENT
Administered in flexible order after FQ and RH sections are completed.
BOX USBEG

CONREFFN

USCONREF

routing

code one

IF USDISP = 1/ConsentRequired OR USDISP = 4/InitialRefusal, GO TO USCONREF - CONREFFN.
ELSE GO TO US1PRE - US1PRECT.

PLEASE INDICATE THE FINAL (CONSENT/REFUAL) STATUS FOR THIS SECTION.

This series of questions is about the health care services that (SP) may have received between (US REFERENCE
START DATE) and (US REFERENCE END DATE) while (he/she) resided in (FACILITY).

US1PRECT

US1PRE

code one

[The questions include any services that (he/she) received outside this (facility/home), as well as care from any
providers who saw (him/her) here. The kinds of services I will be asking about include physician care, dental care,
mental health services, various kinds of therapies, and care from other kinds of health care providers. I will be
asking about the type of provider and the frequency or duration of the services. Please do not include care while
(he/she) was an overnight inpatient in an acute care hospital.]
IF THERE ARE NO CONSENT OR REFUSAL ISSUES FOR THIS SECTION, PRESS "1" TO CONTINUE.

OUTMDVST

US1

yes/no

Between (US REFERENCE START DATE) and (US REFERENCE END DATE) while a resident in this
(facility/home), did (SP) see a medical doctor of any kind, outside the (facility/home), excluding mental health
therapy provided by a psychiatrist?

OUTMDFRQ

US2

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many times did (he/she) see
doctors outside this (facility/home)?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US3 – INMDVST
(-8) US3 – INMDVST
(-9) US3 – INMDVST

yes/no

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), did (he/she) see a medical doctor
of any kind, here, in this (facility/home), excluding mental health therapy provided by a psychiatrist?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US6PRE - US6PRECT
(01) US5A - ANYMDFRQ
(-8) US3A - US3ACT
(-9) US6PRE - US6PRECT

(01) Continue

(01) BOX USEND

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US6PRE - US6PRECT
(-8) US6PRE - US6PRECT
(-9) US6PRE - US6PRECT

INMDVST

US3

Please tell me the name and title of someone in (FACILITY) who could give me that information.
US3ACT

US3A

code one

Thank you for your time, those are all the questions I have for you. Right now I need to continue with [PERSON
NAMED] to complete these questions.
PRESS "CTRL/R" TO ADD A PERSON TO THE PERSON ROSTER.
PRESS "1" TO CONTINUE.

ANYMDFRQ

US5A

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many times did (he/she) see
any doctor here?

US6PRECT

US6PRE

code one

The following questions are about services used both inside and outside this (facility/home). We are only interested
in services (SP) received while residing in (FACILITY).
(01) Continue
PRESS "1" TO CONTINUE.
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

DENTVST

US6

yes/no

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), did (he/she) see a dentist, dental
surgeon, dental assistant, or any other professional for dental care?

DENTFRQ

US7

Numeric

(01) [Continuous answer.]
Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many times did (he/she) see a
(-8) Don't Know
dentist, dental surgeon, dental assistant, or any other professional for dental care?
(-9) Refused

yes/no

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), did (he/she) see a psychiatrist or
any other mental health care professional either inside or outside this (facility/home)?

MENTLVST

US8

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(01) US6 - DENTVST
(00) US8 - MENTLVST
(01) US7 - DENTFRQ
(-8) US8 - MENTLVST
(-9) US8 - MENTLVST
(01) US8 - MENTLVST
(-8) US8 - MENTLVST
(-9) US8 - MENTLVST
(00) US12 - PHYSTHPY
(01) US9 - PSYCHTYP
(-8) US12 - PHYSTHPY
(-9) US12 - PHYSTHPY

Page 1 of 6

2018 MCBS Facility Instrument

Variable Name

US- Use of Health Services

MR Screen Name Question Type

Question Text/Description
What type of mental health specialist did (he/she) see?

Code List

Routing

(01) LICENSED CLINICAL SOCIAL WORKER
(02) PSYCHIATRIC NURSE
(03) PSYCHIATRIC SOCIAL WORKER
(04) PSYCHIATRIST
(05) PSYCHOLOGIST
(91) OTHER

(01) BOX US10A
(02) BOX US10A
(03) BOX US10A
(04) BOX US10A
(05) BOX US10A
(91) US9 - PSYCHOS

(01) [Continuous Answer]

(01) BOX US10A

PSYCHTYP

US9

code all

[PROBE: Any others?]
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.

PSYCHOS

US9

verbatim

OTHER (SPECIFY)

BOX US10A

routing

IF US9-PSYCHTYP INCLUDES 1/LicensedClinicalSocWork, GO TO US10A - LCSOWSES.
ELSE GO TO BOX US10B.

US10A

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many sessions or visits did
(he/she) have to a licensed clinical social worker?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US11A - LCSOWTYP
(-8) US11A - LCSOWTYP
(-9) US11A - LCSOWTYP

(01) INDIVIDUAL
(02) GROUP
(03) BOTH

(01) BOX US10B
(02) BOX US10B
(03) BOX US10B

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many sessions or visits did
(he/she) have to a psychiatric nurse?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US11B - PSCNUTYP
(-8) US11B - PSCNUTYP
(-9) US11B - PSCNUTYP

(01) INDIVIDUAL
(02) GROUP
(03) BOTH

(01) BOX US10C
(02) BOX US10C
(03) BOX US10C

LCSOWSES

LCSOWTYP

US11A

code one

Were these individual sessions, group sessions, or some of both?

BOX US10B

routing

IF US9-PSYCHTYP INCLUDES 2/PsychiatricNurse, GO TO US10B - PSCNUSES.
ELSE GO TO BOX US10C.

PSCNUSES

US10B

PSCNUTYP

US11B

code one

Were these individual sessions, group sessions, or some of both?

BOX US10C

routing

IF US9-PSYCHTYP INCLUDES 3/PsychiatricSocWork, GO TO US10C - PSSOWSES.
ELSE GO TO BOX US10D.
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US11C - PSSOWTYP
(-8) US11C - PSSOWTYP
(-9) US11C - PSSOWTYP

(01) INDIVIDUAL
(02) GROUP
(03) BOTH

(01) BOX US10D
(02) BOX US10D
(03) BOX US10D

PSSOWSES

US10C

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many sessions or visits did
(he/she) have to a psychiatric social worker?

PSSOWTYP

US11C

code one

Were these individual sessions, group sessions, or some of both?

BOX US10D

routing

IF US9-PSYCHTYP INCLUDES 4/Psychiatrist, GO TO US10D - PSCIASES.
ELSE GO TO BOX US10E.

PSCIASES

US10D

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many sessions or visits did
(he/she) have to a psychiatrist?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US11D - PSCIATYP
(-8) US11D - PSCIATYP
(-9) US11D - PSCIATYP

PSCIATYP

US11D

code one

Were these individual sessions, group sessions, or some of both?

(01) INDIVIDUAL
(02) GROUP
(03) BOTH

(01) BOX US10E
(02) BOX US10E
(03) BOX US10E

BOX US10E

routing

IF US9-PSYCHTYP INCLUDES 5/Psychologist, GO TO US10E - PSCOLSES.
ELSE GO TO BOX US10F.

PSCOLSES

US10E

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many sessions or visits did
(he/she) have to a psychologist?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US11E - PSCOLTYP
(-8) US11E - PSCOLTYP
(-9) US11E - PSCOLTYP

PSCOLTYP

US11E

code one

Were these individual sessions, group sessions, or some of both?

(01) INDIVIDUAL
(02) GROUP
(03) BOTH

(01) BOX US10F
(02) BOX US10F
(03) BOX US10F

BOX US10F

routing

IF US9-PSYCHTYP INCLUDES 91/Other, GO TO US10F - PSOTRSES.
ELSE GO TO US12 - PHYSTHPY.

PSOTRSES

US10F

Numeric

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), how many sessions or visits did
(he/she) have to a (OTHER MENTAL HEALTH SPECIALIST)?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US11F - PSOTRTYP
(-8) US11F - PSOTRTYP
(-9) US11F - PSOTRTYP

PSOTRTYP

US11F

code one

Were these individual sessions, group sessions, or some of both?

(01) INDIVIDUAL
(02) GROUP
(03) BOTH

(01) US12 - PHYSTHPY
(02) US12 - PHYSTHPY
(03) US12 - PHYSTHPY

Page 2 of 6

2018 MCBS Facility Instrument

Variable Name

PHYSTHPY

US- Use of Health Services

MR Screen Name Question Type

Question Text/Description

Code List

Routing

US12

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), did (he/she) see a therapist such
as a physical therapist, speech therapist, I.V. therapist, occupational therapist, or respiratory therapist?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US22A - PODRTHPY
(01) US13 - PHTPYWKL
(-8) US22A - PODRTHPY
(-9) US22A - PODRTHPY

(01) LESS THAN ONCE A WEEK
(02) ONCE OR TWICE A WEEK
(03) 3 TO 5 TIMES A WEEK
(04) MORE THAN 5 TIMES A WEEK
(05) ONE-TIME EVALUATION
(-8) Don't Know
(-9) Refused

(01) US14 – PHTPYFRQ
(02) US14 – PHTPYFRQ
(03) US14 – PHTPYFRQ
(04) US14 – PHTPYFRQ
(05) US22A - PODRTHPY
(-8) US14 – PHTPYFRQ
(-9) US22A - PODRTHPY
(01) US22A - PODRTHPY
(02) US22A - PODRTHPY
(03) US22A - PODRTHPY
(04) US22A - PODRTHPY
(05) US22A - PODRTHPY
(-8) US22A - PODRTHPY
(-9) US22A - PODRTHPY

yes/no

SHOW CARD US1
PHTPYWKL

US13

code one

Please look at this card and tell me about how often each week therapy was provided.
PRESS F1 FOR INFORMATION ON "ONE-TIME EVALUATION".

PHTPYFRQ

PODRTHPY

EDHBSERV

EDUORHAB

EDHABFRQ

HABFRQ

OTHCPROV

US14

US22A

US23

US24

code one

SHOW CARD US2
Now look at this card. Between (US REFERENCE START DATE) and (US REFERENCE END DATE), over how
long a period was therapy provided?

(01) LESS THAN 1 WEEK
(02) 1 TO 3 WEEKS
(03) 4 TO 8 WEEKS
(04) MORE THAN 8 WEEKS BUT NOT THE WHOLE
TIME
(05) ABOUT THE WHOLE TIME
(-8) Don't Know
(-9) Refused

yes/no

Between (US REFERENCE START DATE) and (US REFERENCE END DATE) was (SP) seen by a podiatrist
(either inside or outside this (facility/home))?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US23 - EDHBSERV
(01) US23 - EDHBSERV
(-8) US23 - EDHBSERV
(-9) US23 - EDHBSERV

yes/no

Between (US REFERENCE START DATE) and (US REFERENCE END DATE), did (he/she) receive educational or (00) NO
habilitational services (either inside or outside this (facility/home))?
(01) YES
(-8) Don't Know
[PROBE: "Habilitational services" include training in daily living skills, self care, and so on, in a structured program.] (-9) Refused

(00) US29 - OTHCPROV
(01) US24 - EDUORHAB
(-8) US29 - OTHCPROV
(-9) US29 - OTHCPROV

(01) EDUCATIONAL
(02) HABILITATIONAL
(03) BOTH
(-8) Don't Know
(-9) Refused

(01) US25 - EDHABFRQ
(02) US25 - EDHABFRQ
(03) US25 - EDHABFRQ
(-8) US25 - EDHABFRQ
(-9) US29 - OTHCPROV

code one

Were those services educational, habilitational, or both?

US25

code one

(01) LESS THAN 1 WEEK
(02) 1 TO 3 WEEKS
(03) 4 TO 8 WEEKS
SHOW CARD US2
(04) MORE THAN 8 WEEKS BUT NOT THE WHOLE
Please look at this card and tell me, between (US REFERENCE START DATE) and (US REFERENCE END DATE),
TIME
over how long a period were these (educational/habilitational) services provided?
(05) ABOUT THE WHOLE TIME
(-8) Don't Know
(-9) Refused

BOX US2

routing

IF US24-EDUORHAB = 3/Both, THEN GO TO US27 - HABFRQ.
ELSE GO TO US29 - OTHCPROV.

code one

(01) LESS THAN 1 WEEK
(02) 1 TO 3 WEEKS
(03) 4 TO 8 WEEKS
SHOW CARD US2
(04) MORE THAN 8 WEEKS BUT NOT THE WHOLE
Between (US REFERENCE START DATE) and (US REFERENCE END DATE), over how long a period were these
TIME
habilitational services provided?
(05) ABOUT THE WHOLE TIME
(-8) Don't Know
(-9) Refused

(01) US29 - OTHCPROV
(02) US29 - OTHCPROV
(03) US29 - OTHCPROV
(04) US29 - OTHCPROV
(05) US29 - OTHCPROV
(-8) US29 - OTHCPROV
(-9) US29 - OTHCPROV

yes/no

SHOW CARD US3 FOR PROMPTING AS NEEDED.
(00) NO
Between (US REFERENCE START DATE) and (US REFERENCE END DATE), did (he/she) receive care from any (01) YES
other licensed or certified health care provider (either inside or outside this (facility/home))?
(-8) Don't Know
PRESS F1 FOR "ANY OTHER PROVIDER" CLARIFICATION.
(-9) Refused

(00) US31PRE - US31PRCT
(01) US30 - TYPHCPRV
(-8) US31PRE - US31PRCT
(-9) US31PRE - US31PRCT

US27

US29

(01) BOX US2
(02) BOX US2
(03) BOX US2
(04) BOX US2
(05) BOX US2
(-8) BOX US2
(-9) BOX US2

Page 3 of 6

2018 MCBS Facility Instrument

Variable Name

US- Use of Health Services

MR Screen Name Question Type

Question Text/Description

Code List

Routing
(01) US31PRE - US31PRCT
(02) US31PRE - US31PRCT
(03) US31PRE - US31PRCT
(04) US31PRE - US31PRCT
(05) US31PRE - US31PRCT
(06) US31PRE - US31PRCT
(07) US31PRE - US31PRCT
(08) US31PRE - US31PRCT
(09) US31PRE - US31PRCT
(10) US31PRE - US31PRCT
(11) US31PRE - US31PRCT
(91) US30 - TYPPRVOS

TYPHCPRV

US30

code all

What kind of provider was that?
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.

(01) AUDIOLOGIST
(02) DIETICIAN
(03) LABORATORY TECHNICIAN
(04) NURSE PRACTITIONER
(05) OPHTHALMOLOGIST
(06) OPTOMETRIST
(07) PHYSICIAN'S ASSISTANT
(08) RECREATIONAL THERAPIST
(09) REGISTERED NURSE
(10) SOCIAL WORKER
(11) X-RAY TECHNICIAN
(91) OTHER

TYPPRVOS

US30

verbatim

OTHER (SPECIFY)

(01) [Continuous Answer]

(01) US31PRE - US31PRCT

code all

The next few questions are about any visits (SP) may have made to a hospital emergency room from (US
REFERENCE START DATE) through (US REFERENCE END DATE). Please do not include visits to the
emergency room that were immediately followed by inpatient hospital stays.

(01) Continue

(01) US32 - ERVISITS

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US37 - RETSMDAY
(01) US33 - ERVSTMM
(-8) US37 - RETSMDAY
(-9) US37 - RETSMDAY

US31PRCT

US31PRE

PRESS "1" TO CONTINUE.

ERVISITS

ERVSTMM

US32

US33

yes/no

grid

While (he/she) was in this (facility/home), did (he/she) make any visits to a hospital emergency room between (US
REFERENCE START DATE) and (US REFERENCE END DATE)?

COLLECT ALL ER VISITS.
Please tell me all dates (SP) made a visit to a hospital emergency room between (US REFERENCE START DATE)
(01) [Continuous answer.]
and (US REFERENCE END DATE).
(-8) Don't Know
[PROBE: Were there any more visits to the ER?]
(-9) Refused

(01) US33 - ERVSTDD
(-8) US33 - ERVSTDD
(-9) US33 - ERVSTDD

IF NO MORE DATES, PRESS ENTER TO CONTINUE.

ERVSTDD

US33

grid

COLLECT ALL ER VISITS.
Please tell me all dates (SP) made a visit to a hospital emergency room between (US REFERENCE START DATE)
(01) [Continuous answer.]
and (US REFERENCE END DATE).
(-8) Don't Know
[PROBE: Were there any more visits to the ER?]
(-9) Refused

(01) US33 - ERVSTYY
(-8) US33 - ERVSTYY
(-9) US33 - ERVSTYY

IF NO MORE DATES, PRESS ENTER TO CONTINUE.

ERVSTYY

US33

grid

COLLECT ALL ER VISITS.
Please tell me all dates (SP) made a visit to a hospital emergency room between (US REFERENCE START DATE)
(01) [Continuous answer.]
and (US REFERENCE END DATE).
(-8) Don't Know
[PROBE: Were there any more visits to the ER?]
(-9) Refused

(01) BOX US33
(-8) BOX US33
(-9) BOX US33

IF NO MORE DATES, PRESS ENTER TO CONTINUE.
BOX US33

routing

CREATE NEW EMERGENCY ROOM VISITS FOR EACH DATE ADDED AND GO TO US37 - RETSMDAY.
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US40 - USEEQUIP
(01) US38 - RETSMFRQ
(-8) US40 - USEEQUIP
(-9) US40 - USEEQUIP

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

(01) US40 - USEEQUIP
(-8) US40 - USEEQUIP
(-9) US40 - USEEQUIP

RETSMDAY

US37

yes/no

[Besides the (health care providers and emergency room/health care providers/emergency room) visits you have
already told me about, did (he/she) ever go to the hospital and return on the same day/Did (he/she) ever go to the
hospital and return on the same day]?

RETSMFRQ

US38

Numeric

How many times did this happen between (US REFERENCE START DATE) and (US REFERENCE END DATE)?

Page 4 of 6

2018 MCBS Facility Instrument

Variable Name

USEEQUIP

USEEQUI2

US- Use of Health Services

MR Screen Name Question Type

Question Text/Description

US40

code all

(01) AMBULANCE SERVICE
(02) CLOTH DIAPERS
(03) DIABETIC EQUIPMENT OR SUPPLIES
(04) DISPOSABLE DIAPERS
(05) EQUIPMENT OR SUPPLIES FOR KIDNEY
SHOW CARD US4
DIALYSIS
Now I'd like to ask you about any kind of supplies, equipment, or other types of medical services (SP) received other
(06) EYE GLASSES OR CONTACT LENSES
than the ones I've already mentioned. Please look at this first card and tell me what supplies or services (SP)
(07) HEARING AID OR OTHER COMMUNICATION
received between (US REFERENCE START DATE) and (US REFERENCE END DATE).
DEVICE
(08) ORTHOPEDIC ITEMS
SELECT ALL THAT APPLY.
(09) OSTOMY SUPPLIES
SEPARATE RESPONSES BY USING THE SPACEBAR.
(10) OXYGEN
(11) PROSTHESIS
(96) NONE OF THE ABOVE
(-8) Don't Know
(-9) Refused

BOX US3

routing

IF US40-USEEQUIP INCLUDES DK OR RF, GO TO US43 - MSTURN.
ELSE GO TO US42 - USEEQUI2.

US42

code all

SHOW CARD US5
Please look at this second card and tell me what medical devices or equipment (he/she) received between (US
REFERENCE START DATE) and (US REFERENCE END DATE).
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.

OTHREQOS

MSTURN

MSTUBE

MSRESTR

MSINJECT

US42

US43

US43

US43

US43

Code List

Routing

(01) BOX US3
(02) BOX US3
(03) BOX US3
(04) BOX US3
(05) BOX US3
(06) BOX US3
(07) BOX US3
(08) BOX US3
(09) BOX US3
(10) BOX US3
(11) BOX US3
(96) BOX US3
(-8) BOX US3
(-9) BOX US3

(01) BEDSIDE COMMODE
(02) BED PADS (CLOTH OR DISPOSABLE)
(03) CATHETER AND CATHETER SUPPLIES
(04) FEEDING SUPPLIES (INCLUDE PUMPS,
SYRINGES, TUBES)
(05) G TUBE AND SUPPLIES
(06) GERI CHAIR
(07) HOSPITAL BED
(08) IV SUPPLIES
(09) NEBULIZER
(10) SPECIAL MATTRESS, CUSHIONS OR MATTRESS
PADS (INCLUDING EGG CRATE, AIR)
(11) SUCTION MACHINE AND SUPPLIES
(12) TED HOSE AND SUPPLIES
(13) WHEELCHAIR/WALKER
(91) SOME OTHER TYPE OF DEVICE OR EQUIPMENT
(96) NONE OF THE ABOVE

(01) US43 - MSTURN
(02) US43 - MSTURN
(03) US43 - MSTURN
(04) US43 - MSTURN
(05) US43 - MSTURN
(06) US43 - MSTURN
(07) US43 - MSTURN
(08) US43 - MSTURN
(09) US43 - MSTURN
(10) US43 - MSTURN
(11) US43 - MSTURN
(12) US43 - MSTURN
(13) US43 - MSTURN
(91) US42 - OTHREQOS
(96) US43 - MSTURN

verbatim

SOME OTHER TYPE OF DEVICE OR EQUIPMENT (SPECIFY)

(01) [Continuous Answer]

(01) US43 - MSTURN

list

Please tell me if (SP) received any of the following medical services. Did (he/she) receive… turning and
positioning?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US43 - MSTUBE
(01) US43 - MSTUBE
(-8) US43 - MSTUBE
(-9) US43 - MSTUBE

Please tell me if (SP) received any of the following medical services. Did (he/she) receive… tubefeeding?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US43 - MSRESTR
(01) US43 - MSRESTR
(-8) US43 - MSRESTR
(-9) US43 - MSRESTR

Please tell me if (SP) received any of the following medical services. Did (he/she) receive… restraints?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US43 – MSINJECT
(01) US43 – MSINJECT
(-8) US43 – MSINJECT
(-9) US43 – MSINJECT

Please tell me if (SP) received any of the following medical services. Did (he/she) receive… injections?

(00) NO
(01) YES
(-8) Don't Know
(-9) Refused

(00) US45 - OTHMEDNC
(01) US45 - OTHMEDNC
(-8) US45 - OTHMEDNC
(-9) US45 - OTHMEDNC

list

list

list

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2018 MCBS Facility Instrument

Variable Name

OTHMEDNC

US- Use of Health Services

MR Screen Name Question Type

US45

code all

Question Text/Description

SHOW CARD US6
Now I'd like to ask about any other medically necessary items or provider services (SP) received that we haven't
talked about already. Please look at this last card and tell me what other items or services (he/she) received
between (US REFERENCE START DATE) and (US REFERENCE END DATE)?
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.

OTHRSEOS

DIDABUS

US45

US46

verbatim

code one

SOME OTHER KIND OF ITEM OR SERVICE (SPECIFY)

Code List

Routing

(01) APPLYING/CHANGING DRESSINGS INCLUDING
BAND-AIDS
(02) APPLYING/MONITORING HOT PACKS
(03) CATHETERIZATION AND IRRIGATION
(04) FEEDING (WITH SPOON SYRINGE PUMP OR
OTHER DEVICE)
(05) G TUBE USE AND CARE
(06) INCONTINENCE
(07) IV USE AND CARE
(08) PACEMAKER CHECK
(09) SKIN TREATMENTS FOR
PREVENTION/TREATMENT OF SKIN ULCERS
(10) SUCTIONING
(91) SOME OTHER KIND OF ITEM OR SERVICE
(96) NONE OF THE ABOVE
(-8) Don't Know

(01) US46 - DIDABUS
(02) US46 - DIDABUS
(03) US46 - DIDABUS
(04) US46 - DIDABUS
(05) US46 - DIDABUS
(06) US46 - DIDABUS
(07) US46 - DIDABUS
(08) US46 - DIDABUS
(09) US46 - DIDABUS
(10) US46 - DIDABUS
(91) US45 - OTHRSEOS
(96) US46 - DIDABUS
(-8) US46 - DIDABUS

(01) [Continuous Answer]

(01) US46 – DIDABUS

TO ABSTRACT MEANS TO OBTAIN INFORMATION FROM THE BENEFICIARY'S RECORDS FOR ENTRY INTO
THE QUESTIONNAIRE. EXAMPLES OF RECORDS YOU MAY HAVE ABSTRACTED FROM INCLUDE THE
MINIMUM DATA SET (MDS), NURSES NOTES, PHYSICIANS ORDERS, AND/OR OTHER DOCUMENTS
(01)ALL
PROVIDED BY THE FACILITY.
(02) MAJORITY
(03) HALF
USE YOUR BEST JUDGMENT TO DETERMINE WHICH ANSWER IS THE MOST ACCURATE CHOICE FOR THE (04) SOME
AMOUNT YOU ABSTRACTED. IF THERE WAS NO ABSTRACTION AT ALL, PLEASE SELECT "NONE".
(05) NONE

(01) US47 - WHYABUS
(02) US47 - WHYABUS
(03) US47 - WHYABUS
(04) US47 - WHYABUS
(05) USEND - USENDCT

DID YOU ABSTRACT?

WHYABUS

US47

code one

WHY DID YOU ABSTRACT

(01) NO KNOWLEDGEABLE RESPONDENT
AVAILABLE
(02) NO TIME/STAFF BURDEN TOO GREAT
(03) REFUSAL--UNWILLING TO COOPERATE
(91) OTHER

WHYABUOS

US47

verbatim

OTHER (SPECIFY)

(01) [Continuous Answer]

(01) USEND - USENDCT

USENDCT

USEND

code one

(YOU HAVE COMPLETED THE USE SECTION FOR THIS SP.)
PRESS "1" TO RETURN TO NAVIGATION SCREEN.

(01) Continue

(01) BOX USEND

BOX USEND

routing

GO TO NAVIGATOR

(01) USEND – USENDCT
(02) USEND – USENDCT
(03) USEND – USENDCT
(91) US47 - WHYABUOS

Page 6 of 6