CMS-P-0015A Usual Source of Care

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question type

Question text/description

Code List

Routing

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

(01) US2 - PLACEKND
(02) BOX USA
(-8) BOX USA
(-9) BOX USA

USUAL SOURCE OF CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after KNQ.

PLACEPAR

US1

BOX USA

yes/no

Is there a particular doctor or other health professional, or a clinic [you/(SP)]
usually [go/goes] to when [you are/he is/she is] sick or for advice about
[your/his/her] health?

routing

IF (INTTYPE=7) AND SP ever reported speaking a language other than English
in the home (SAMPLE_PERSON.WHATLANG EQUALS 1-"SPANISH", 2"FRENCH", 3-"GERMAN", OR 91-"Other, Specify") AND P_ENGWELL=1, GO
TO LEP6-LANGPROB.
ELSE GO TO US39 – NUSNOTSK.

(01) BOX USB
(02) BOX USB
(03) US3A - CLNAME
(04) US3A - CLNAME
(05) US3A - CLNAME
(06) US3A - CLNAME
(07) US3A - CLNAME
(08) US3A - CLNAME
(09) US3A - CLNAME
(10) US5A - MDNAME
(11) US3A - CLNAME
(12) US3A - CLNAME
(13) US3A - CLNAME
(14) US3A - CLNAME
(91) US2 - PLACEOS
(-8) US3A - CLNAME
(-9) US3A - CLNAME

(01) CONTINUOUS ANSWER

US3A - CLNAME

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

BOX USC

PLACEKND

US2

code one

(01) DOCTOR'S OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY HEALTH CENTER
(05) FREESTANDING SURGICAL CENTER
(06) RURAL HEALTH CLINIC
What kind of place [do you/does (SP)] usually go to when [you are/he is/she is]
(07) COMPANY CLINIC
sick or for advice about [your/his/her] health -- is that a managed care plan or
(08) OTHER CLINIC
HMO center, a clinic, a doctor or other health professional's office, a hospital, or
(09) WALK-IN URGENT CENTER
some other place?
(10) DOCTOR COMES TO SP'S HOME
(11) HOSPITAL EMERGENCY ROOM
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind of clinic?
(12) HOSPITAL OUTPATIENT
IF SOME OTHER PLACE, ASK: Where is this?
DEPARTMENT/CLINIC
(13) VA FACILITY
(14) MENTAL HEALTH CENTER
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

PLACEOS

US2

text

OTHER (SPECIFY)

routing

IF SP WAS COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND, GO TO US2A - PLACEMCP.
ELSE IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.

yes/no

Is this [doctor or other health professional/medical clinic] associated with
[your/his/her] [READ MANAGED CARE PLAN NAME(S) BELOW] plan?

BOX USB

PLACEMCP

US2A

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

BOX USC

routing

IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.

What is the complete name of the [place/managed care plan or HMO
center/(US2 RESPONSE)] that [you go to/(SP) goes to]?
CLNAME

USUALDOC

US3A

US4

verbatim text

yes/no

[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE
DIRECTORY, APPOINTMENT CARD, ETC., FOR COMPLETE
INFORMATION.]

Is there a particular doctor or other health professional [you usually see/(SP)
usually sees] at this [place/managed care plan or HMO center/(US2
RESPONSE)]?

(01) continuous answer

US4 - USUALDOC

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

(01) US5A - MDNAME
(02) BOX USD US7-INNOVATE
(-8) US8 - GETUSHOW
(-9) US8 - GETUSHOW

(01) CONTINUOUS ANSWER

MDSEX - US5B

(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED

US6A - MDSPEC

What is the complete name of that doctor or other health professional?
MDNAME

MDSEX

US5A

US5B

verbatim text

code one

[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE
DIRECTORY, APPOINTMENT CARD, ETC., FOR COMPLETE
INFORMATION.]

Is (US5A PROVIDER NAME) a male or female?

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

SHOW CARD US1
What is (US5A PROVIDER NAME)'s specialty?

MDSPEC

US6A

code one

[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF
THEY MENTION A 'GENERIC' SPECIALITY LIKE ‘HEART DOCTOR.’ IF
RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE GENERIC
WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE
RESPONSES, SELECT THE RESPONSE CATEGORY FOR THAT
SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]

(01) ALLERGY/IMMUNOLOGY
(02) ANESTHESIOLOGY
(03) CARDIOLOGY (HEART)
(05) DERMATOLOGY (SKIN)
(07) ENDOCRINOLOGY/ METABOLISM (DIABETES,
THYROID)
(08) FAMILY PRACTICE
(09) GASTROENTEROLOGY
(10) GENERAL PRACTICE
(11) GENERAL SURGERY
(12) GERIATRICS (ELDERLY)
(13) GYNECOLOGY - OBSTETRICS
(14) HEMATOLOGY (BLOOD)
(15) HOSPITAL RESIDENCE
(16) INTERNAL MEDICINE (INTERNIST)
(17) NEPHROLOGY (KIDNEYS)
(18) NEUROLOGY
(19) NUCLEAR MEDICINE
(20) ONCOLOGY (TUMORS, CANCER)
(21) OPHTHALMOLOGY (EYES)
(22) ORTHOPEDICS
(24) OSTEOPATHY (DO)
(25) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
(26) PATHOLOGY
(27) PHYS MED/REHAB
(36) PHYSICIAN’S ASSISTANT
(28) PLASTIC SURGERY
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(91) OTHER DR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED

(01)-(05) BOX USD US7-INNOVATE
(07)-(36) BOX USD US7-INNOVATE
(91) US6A - MDSPECOS
(-8) BOX USD US7-INNOVATE
(-9) BOX USD US7-INNOVATE

(01) CONTINUOUS ANSWER

BOX USD

OTHER DR SPECIALTY (SPECIFY)

MDSPECOS

US6A

text

[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF
THEY MENTION A 'GENERIC' SPECIALITY LIKE ‘HEART DOCTOR.’ IF
RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE GENERIC
WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE
RESPONSES, SELECT THE RESPONSE CATEGORY FOR THAT
SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

Many health care providers are beginning to participate in innovative health care
initiatives, programs, and payment models. Is (US5A PROVIDER NAME)/(US3A
PROVIDER NAME) associated with an innovative health care initiative such as
an accountable care organization or a patient centered medical home?
INNOVATE

US7

yes/no

IF NEEDED: Innovative health care initiatives are programs that test ways to
improve the delivery of health care, improve the quality of health care, lower
health care costs, and reduce health disparities.

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

BOX USD

(01) LEP4-LANGSYMP
(02) LEP2-LANGPRVD
(03) LEP2-LANGPRVD
(91) LEP1B-LANGPFOS
(-8) LEP2-LANGPRVD
(-9) LEP2-LANGPRVD

IF THE RESPONDENT DOESN'T KNOW WHAT INNOVATIVE HEALTH CARE
INITATIVES ARE OR HAS NEVER HEARD OF INNOVATIVE HEALTH CARE
INITIATIVES, SELECT 'DON'T KNOW'.

BOX USD

routing

IF (INTTYPE=7) AND (SAMPLE_PERSON.WHATLANG EQUALS 1"SPANISH", 2-"FRENCH", 3-"GERMAN", OR 91-"Other, Specify"), GO TO
LEP1A-LANGPREF.
ELSE, GO TO BOX US1.

LANGPREF

LEP1A

select one

In general, in what language [do you/does (SP)] prefer to receive [your/his/her]
medical care?

(01) English
(02) [LANGUAGE SPOKEN AT HOME], or
(03) Both English and [LANGUAGE SPOKEN AT
HOME] equally
(91) OTHER
(-8) Don't Know
(-9) Refused

LANGPFOS

LEP1B

verbatim text

In general, in what language [do you/does (SP)] prefer to receive [your/his/her]
medical care?

(01) CONTINUOUS ANSWER

LEP2-LANGPRVD

select one

[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER
NAME)] speak [LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS]?

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

(01) LEP3-LANGCOMM
(02) LEP4-LANGSYMP
(-8) LEP4-LANGSYMP
(-9) LEP4-LANGSYMP

LANGPRVD

LEP2

SHOW CARD US2
LANGCOMM

LEP3

select one

(01) VERY WELL
(02) WELL
How well can [you/(SP)] and [(US5A PROVIDER NAME)/the providers at (US3A (03) NOT WELL
PROVIDER NAME)] communicate in [LANGUAGE SPOKEN AT HOME/LEP1B- (04) NOT AT ALL
LANGPFOS] about [your/his/her] symptoms? Very well, well, not well, or not at
(-8) DON’T KNOW
all?
(-9) REFUSED

BOX LEP1

routing

IF P_ENGWELL=1, GO TO LEP6-LANGPROB. ELSE GO TO BOX US1.

BOX LEP1

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

SHOW CARD US2
LANGSYMP

LEP4

select one

(01) VERY WELL
(02) WELL
Without the aid of a translator, language assistant, or interpreter, how well can
(03) NOT WELL
[you/(SP)] and [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER (04) NOT AT ALL
NAME)] communicate in English about [your/his/her] symptoms? Very well, well, (-8) DON’T KNOW
not well, or not at all?
(-9) REFUSED

BOX LEP2

routing

IF P_ENGWELL=1, GO TO LEP5-LANGASST. ELSE GO TO BOX US1.

SHOW CARD US3

LANGASST

LEP5

select all

Who helps [you/(SP)] communicate with [(US5A PROVIDER NAME)/the
providers at (US3A PROVIDER NAME)] – a professional interpreter, a staff
person at [your/his/her] provider's office, a family member, a friend, or do
[you/(SP)] do the best that [you/(SP)] can in English?
PROBE: Anyone else?

LANGPROB

LEP6

select one

(01) YES
Have [you/(SP)] ever had a problem understanding a medical situation because (02) NO
it was not explained in [LANGAUGE SPOKEN AT HOME/LEP1B-LANGPFOS]? (-8) DON’T KNOW
(-9) REFUSED
SHOW CARD US3
Now think about all of [your/(SP)'s] medical providers other than [your/his/her]
usual provider.

LANGHELP

LEP7

select all

Who helps [you/(SP)] communicate with medical providers who do not speak
[LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS]– a professional
interpreter, a staff person at [your/his/her] provider's office, a family member, a
friend, or do [you/(SP)] do the best that [you/(SP)] can in English?
PROBE: Anyone else?

BOX US1

routing

US8

code one

GETUSOS

US8

verbatim text

LEP6-LANGPROB

LEP7-LANGHELP

(01) PROFESSIONAL INTERPRETER
(02) STAFF PERSON AT MEDICAL PROVIDER’S
OFFICE
(03) FAMILY MEMBER
(04) FRIEND
(05) SOMEONE ELSE
(06) DOES BEST THAT CAN IN ENGLISH
(07) DOES NOT SEE A MEDICAL PROVIDER
(-8) DON’T KNOW
(-9) REFUSED

BOX US1

(01) WALKING
(02) DRIVING
(03) BEING DRIVEN
(04) AMBULANCE OR OTHER SPECIAL VEHICLE
(05) TAXI
(06) OTHER PUBLIC TRANSPORTATION
(07) DR. USUALLY COMES TO HOME
(91) SOME OTHER WAY
(-8) DON'T KNOW
(-9) REFUSED

(01) US9 - GETUSUNT
(02) US9 - GETUSUNT
(03) US9 - GETUSUNT
(04) US9 - GETUSUNT
(05) US9 - GETUSUNT
(06) US9 - GETUSUNT
(07) PP1A-PROVYR
(91) US8 - GETUSOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

(01) continuous answer

US9 - GETUSUNT

IF US1 - PLACEPAR = NO, DK, or RF, GO TO US39 - NUSNOTSK.
ELSE IF US2 - PLACEKND = 10/AtHome, GO TO PP1A-PROVYR.
ELSE GO TO US8 - GETUSHOW.

How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)]?
GETUSHOW

(01) PROFESSIONAL INTERPRETER
(02) STAFF PERSON AT MEDICAL PROVIDER’S
OFFICE
(03) FAMILY MEMBER
(04) FRIEND
(05) SOMEONE ELSE
(06) DOES BEST THAT CAN IN ENGLISH
(-8) DON’T KNOW
(-9) REFUSED

BOX LEP2

[EXPLAIN IF NECESSARY: [Do you/Does (SP)] get there by walking, driving,
being driven by someone else, by ambulance or other special vehicle for
disabled people, by taxi, other public transportation, or some other way?]

SOME OTHER WAY (SPECIFY)

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

GETUSUNT

US9

code one

About how long does it usually take for [you/(SP)] to get there?

(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) DON'T KNOW
(-9) REFUSED

GETUSHRS

US9

numeric

HOURS:

(01) CONTINUOUS ANSWER

If US9 GETUSUNT=3/HoursAndMinutes go
to US9 - GETUSMIN.
Else go to US10 - ACCOMPUS.

GETUSMIN

US9

numeric

MINUTES:

(01) CONTINUOUS ANSWER

US10 - ACCOMPUS

[Do you/Does (SP)] usually have someone accompany [you/him/her] there?

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

(01) US11 - PERSON_USUALGO
(02) PP1A-PROVYR
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

ACCOMPUS

US10

PERSON_USUALGO US11

ROSTFNAM
ROSTLNAM

US11_NEW
US11_NEW

yes/no

roster

text
text

Who usually goes with [you/(SP)]?
SELECT OR ADD ONLY ONE PERSON

[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/OtherRelative or 92/OtherNonRelative, display ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

(01) CONTINUOUS ANSWER
(01) CONTINUOUS ANSWER

(01) US9 - GETUSHRS
(02) US9 - GETUSMIN
(03) US9 - GETUSHRS
(-8) US10 - ACCOMPUS
(-9) US10 - ACCOMPUS

(01-N) US11AA-ACCREAS
(N+1) US11_NEW-ROSTFNAM
IF EXISTING PERSON SELECTED, GO
TO US11AA-ACCREAS.
ELSE IF "ADD ANOTHER" SELECTED,
GO TO US11_NEW-ROSTFNAM

US11_NEW - ROSTLNAM
US11_NEW - ROSTREL

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

ROSTREL

US11_NEW

code one

[What is the name of the person and relationship to (SP)?]

ROSTREOS

US11_NEW

verbatim text

[What is the name of the person and relationship to (SP)?]

What are the reasons [you accompany (SP)/this person accompanies you/this
person accompanies this person] do?
ACCREAS

US11AA

code all

[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

ACCOTHOS

PROVYR

US11AA

PP1A

verbatim text

OTHER (SPECIFY)

code one

[Have you/Has (SP)] seen [(US5A PROVIDER NAME)/(US3A PROVIDER
NAME)] in the last 12 months?

The next questions ask about the care [you/(SP)] received from [(US5A
PROVIDER NAME)'S office/(US3A PROVIDER NAME)].
REMINDAPPT

PP1

yes/no

Some offices remind patients about appointments. Before [your/(SP)'s] most
recent visit with [(US5A PROVIDER NAME)/(US3A PROVIDER NAME) ], did
[you/he/she] get a reminder from [(US5A PROVIDER NAME)'S office /(US3A
PROVIDER NAME)] about the appointment?

(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) WRITES DOWN WHAT DOCTOR
SAYS/RECORDS INSTRUCTIONS/TAKES
NOTES/REMEMBERS
(02) GIVES INFORMATION/EXPLAINS SP'S
MEDICAL CONDITION OR NEEDS TO THE
DOCTOR
(03) EXPLAINS DOCTOR’S INSTRUCTIONS TO SP
(04) ASKS QUESTIONS
(05) TRANSLATES LANGUAGE
(06) SCHEDULES APPOINTMENTS
(07) NOTHING/KEEPS SP COMPANY/SITS WITH
SP/MORAL SUPPORT
(08) TRANSPORTATION
(09) SP NEEDS PHYSICAL ASSISTANCE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer

(01) DO NOT DISPLAY
(02) US11AA-ACCREAS
(03) US11AA-ACCREAS
(04) US11AA-ACCREAS
(05) US11AA-ACCREAS
(06) US11AA-ACCREAS
(07) US11AA-ACCREAS
(08) US11AA-ACCREAS
(09) US11AA-ACCREAS
(10) US11AA-ACCREAS
(11) US11AA-ACCREAS
(12) US11AA-ACCREAS
(13) US11AA-ACCREAS
(14) US11AA-ACCREAS
(50) DO NOT DISPLAY
(51) US11AA-ACCREAS
(52) US11AA-ACCREAS
(53) US11AA-ACCREAS
(54) US11AA-ACCREAS
(55) US11AA-ACCREAS
(56) US11AA-ACCREAS
(57) US11AA-ACCREAS
(91) US11_NEW - ROSTREOS
(-8) US11AA-ACCREAS
US11AA-ACCREAS

(01) PP1A-PROVYR
(02) PP1A-PROVYR
(03) PP1A-PROVYR
(04) PP1A-PROVYR
(05) PP1A-PROVYR
(06) PP1A-PROVYR
(07) PP1A-PROVYR
(08)PP1A-PROVYR
(09) PP1A-PROVYR
(91) US11AA - ACCOTHOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

PP1A-PROVYR

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

(01) PP1-REMINDAPPT
(02) BOX US3
(-8) BOX US3
(-9) BOX US3

(01) YES
(02) NO
(996) NOT APPLICABLE / R DID NOT HAVE
APPOINTMENT
(-8) DON'T KNOW
(-9) REFUSED

PP2- PREPARE

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

PREPARE

PP2

yes/no

Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)/(US3A
PROVIDER NAME)], did [you/he/she] get instructions telling [you/him/her] what
to expect or how to prepare?

(01) YES
(02) NO
(996) NOT APPLICABLE / R DID NOT HAVE
APPOINTMENT
(-8) DON'T KNOW
(-9) REFUSED

SHOW CARD US4

MISSAPPT

PP4

code one

(01) NEVER
Now I’m going to read you questions about the medical providers [you have/SP (02) SOMETIMES
has] seen in the last twelve months, that is since {TODAY'S MONTH AND YEAR (03) USUALLY
- 12 MONTHS}.
(04) ALWAYS
(-8) Don't Know
People have busy lives and miss appointments for many reasons. Since
(-9) Refused
(TODAY'S MONTH AND YEAR-12 MONTHS), how often did [you/(SP)] miss an
appointment with [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)]?

PP4-MISSAPPT

(01) PP8-DOCHLTH
(02) PP5- NEWAPPT
(03) PP5-NEWAPPT
(04) PP5- NEWAPPT
(-8) PP8-DOCHLTH
(-9) PP8-DOCHLTH

SHOW CARD US4

NEWAPPT

PP5

code one

(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [ you/(SP)] missed
(04) ALWAYS
an appointment with US5A PROVIDER NAME/US3A PROVIDER NAME), how
(-8) Don't Know
often did someone from [(US5A PROVIDER NAME)'S office/(US3A PROVIDER
(-9) Refused
NAME)] contact [you/him/her] to make a new appointment?

SHOW CARD US4
DOCHLTH

PP8

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] ask
about things in [your/(SP)'s] work or life at home that affect [your/(SP)'s] health?

SHOW CARD US4
DOCEASY

PP9

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)]
explain things in a way that was easy [for (SP)] to understand?
SHOW CARD US4

DOCLSTN

PP10

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] listen
carefully to [you/(SP)]?

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

PP8-DOCHLTH

PP9- DOCEASY

PP10-DOCLSTN

PP11-DOCRSPCT

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
(04) ALWAYS
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] show
(-8) Don't Know
respect for what [you/(SP)] had to say?
(-9) Refused
(01) NEVER
SHOW CARD US4
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
(04) ALWAYS
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] spend
(-8) Don't Know
enough time with [you/(SP)]?
(-9) Refused
SHOW CARD US4
(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
(04) ALWAYS
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] ask
(-8) Don't Know
whether [you/(SP)] had ideas about how to improve [your/his/her] health?
(-9) Refused
SHOW CARD US4

DOCRSPCT

PP11

code one

ENUFTIME

PP12

code one

HLTHIDEA

PP13

code one

SHOW CARD US5

STHLTHGL

PP15

code one

(01) YES, DEFINITELY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER
(02) YES, SOMEWHAT
NAME)/the medical providers at (US3A PROVIDER NAME)] talk with [you/(SP)] (03) NO
about setting goals for [your/his/her] health?
(-8) DON'T KNOW
(-9) REFUSED
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US5

MTHLTHGL

PP16

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did the care [you/(SP)]
received from [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] help [you/(SP)] meet [your/his/her] goals?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

BOX US3

routing

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED

PP12- ENUFTIME

PP13- HLTHIDEA

PP15-STHLTHGL

(01) PP16- MTHLTHGL
(02) PP16- MTHLTHGL
(03) US27-USCKEVRY
(-8) US27-USCKEVRY
(-9) US27-USCKEVRY

BOX US3

GO TO US27-USCKEVRY.
SHOW CARD US6

USCKEVRY

US27

list

USUNWRNG

US27

list

(01) STRONGLY AGREE
Now I am going to read some statements people have made about their health
(02) AGREE
care. Think about the care [you receive/(SP) receives] from (US5A PROVIDER
(03) DISAGREE
NAME/US3A PROVIDER NAME). For each statement, please tell me whether
(04) STRONGLY DISAGREE
you strongly agree, agree, disagree, or strongly disagree.
(05) NOT APPLICABLE
(-8) Don't Know
[(US5A PROVIDER NAME) is/The doctors or other health professionals at
(-9) Refused
(US3A PROVIDER NAME) are] very careful to check everything when
examining [you/him/her].
(01) STRONGLY AGREE
SHOW CARD US6
(02) AGREE
(03) DISAGREE
[(US5A PROVIDER NAME) has/The doctors or other health professionals at
(04) STRONGLY DISAGREE
(US3A PROVIDER NAME) have] a complete understanding of the things that
(05) NOT APPLICABLE
are wrong with [you/him/her].
(-8) Don't Know
(-9) Refused

US27-USUNWRNG

BOX US4

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

BOX US4

OTHRSTFF

PP17

routing

IF PP1A-PROVYR= 01/YES, GO TO PP17 OTHRSTFF.
ELSE GO TO BOX US5.

yes/no

People often get instructions about their health from more than one person in the
same office, such as other medical providers, nurses, nutritionists, and social
(01) YES
workers.
(02) NO
(-8) DON'T KNOW
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get any
(-9) REFUSED
instructions about your health from any other staff [in (US5A PROVIDER
NAME)'s office/ at (US3A PROVIDER NAME)]?

(01) PP18- OSUPTODT
(02) PP21- ORDRTEST
(-8) PP21- ORDRTEST
(-9) PP21- ORDRTEST

(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other
(04) ALWAYS
staff seem up-to-date about the care [you were/(SP) was] receiving from [(US5A
(-8) Don't Know
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)]?
(-9) Refused

PP19- OSTLKCR

SHOW CARD US4
OSUPTODT

PP18

code one

SHOW CARD US4
OSTLKCR

PP19

code one

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

PP20- OSNOINFO

(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other (04) ALWAYS
staff seem to know the important information about [your/(SP)'s] medical history? (-8) Don't Know
(-9) Refused

PP21- ORDRTEST

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other
staff talk with [you/(SP)] about care [you/he/she] [were/was] receiving from
[(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)]?

SHOW CARD US4
OSNOINFO

ORDRTEST

PP20

PP21

code one

yes/no

The next set of questions ask about the care you received from [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or
someone in [his/her/their] office.
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in
[his/her/their] office order a blood test, x-ray, or other test for [you/(SP)]?

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

(01) PP22- TSTFLWUP
(02) PP29-HLTHSRVC
(-8) PP29-HLTHSRVC
(-9) PP29-HLTHSRVC

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

SHOW CARD US4

TSTFLWUP

PP22

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)] or someone from
[his/her/their] office ordered a blood test, x-ray, or other test for [you/(SP)], how
often did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone from [his/her/their] office follow up to give
[you/(SP)] those results?

SHOW CARD US4
RQSTRSLT

PP23

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [you/(SP)]
have to request [your/his/her] test results before [you/he/she] got them?
SHOW CARD US4

RSLTEASY

HLTHSRVC

PP24

PP29

code one

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often were
[your/(SP)'s] test results presented in a way that was easy to understand?

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need
services at home to help [you/him/her] take care of [your/his/her] health?

SHOW CARD US4
SRVCHELP

GIVEINST

PP30

PP31

code one

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or
someone in [his/her/their] office help [you/(SP)] get these services at home to
take care of [your/his/her] health?

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)] or someone in
[his/her/their] office give [you/(SP)] instructions about how to take care of
[your/his/her] health?

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

PP23-RQSTRSLT

PP24- RSLTEASY

PP29-HLTHSRVC

(01) PP30- SRVCHELP
(02) PP31- GIVEINST
(-8) PP31- GIVEINST
(-9) PP31- GIVEINST

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

PP31- GIVEINST

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

PP35-ANYRX

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

ANYRX

PP35

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] take any
prescription medicine?
[THIS IS DIFFERENT FROM THE PRESCRIPTION DRUG WHERE WE ASK
IF THE R HAD ANY PRESCRIPTIONS FILLED]

SHOW CARD US4
TALKRX

PP36

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or
someone in [his/her/their] office talk with [you/(SP)] about how [you were/he
was/she was] supposed to take [your/his/her] medicine?

SHOW CARD US4
ASPRSCBD

PP37

code one

There are many reasons why people may not always be able to take their
medicines as prescribed.
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often [were you/was
(SP)] able to take [your/his/her] medicine as prescribed?

SHOW CARD US4
BADRCTN

PP38

code one

BOX US5

routing

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or
someone in [his/her/their] office talk with [you/(SP)] about what to do if [you
have/he has/she has] a bad reaction to [your/his/her] medicine?

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

(01) PP36- TALKRX
(02) BOX US5
(-8) BOX US5
(-9) BOX US5

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

PP37- ASPRSCBD

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

PP38-BADRCTN

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

BOX US5

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

(01) US37B - DRINFRMD
(02) US37I - NOTAVAIL
(-8) US37I - NOTAVAIL
(-9) US37I - NOTAVAIL

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

US37C - REMINDDR

GO TO US37A CARESPCL.

SHOW CARD US1

CARESPCL

US37A

yes/no

Specialists are doctors or other health professionals who specialize in one area
of health care. This card lists some examples of specialists.
Since (TODAY'S MONTH AND YEAR-12 MONTHS) , did [you/(SP)] receive
care from any specialists outside the office of [(US5A PROVIDER NAME)/the
doctors or other health professionals at (US3A PROVIDER NAME)]?

SHOW CARD US4
DRINFRMD

US37B

code one

In general, how often [does (US5A PROVIDER NAME)/do the doctors or other
health professionals at (US3A PROVIDER NAME)] seem informed and up-todate about the care [you get/(SP) gets] from specialists?

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

SHOW CARD US4
REMINDDR

STPMSPCL

US37C

US37D

code one

yes/no

In general, how often [do you/does(SP)] have to remind [(US5A PROVIDER
NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)]
about care [you receive/(SP) receives] from specialists?

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

US37D - STPMSPCL

(01) YES
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did any specialists outside
(02) NO
the office of [(US5A PROVIDER NAME)/the doctors or other health
(-8) DON'T KNOW
professionals at (US3A PROVIDER NAME)] prescribe medicine for [you/(SP)]?
(-9) REFUSED

(01) US37E - TALKPMS
(02) US37E1 - NAMESPCL
(-8) US37E1 - NAMESPCL
(-9) US37E1 - NAMESPCL

(01) NEVER
(02) SOMETIMES
(03) USUALLY
In general, how often [does (US5A PROVIDER NAME)/do the doctors or other
(04) ALWAYS
health professionals at (US3A PROVIDER NAME)] talk with [you/(SP)] about the
(-8) Don't Know
medicines prescribed by these specialists?
(-9) Refused

US37E1 - NAMESPCL

SHOW CARD US4
TALKPMS

US37E

code one

The next four questions ask about care [you/(SP)] received from the specialist
[you/he/she] saw most often in the last 12 months outside the office of [(US5A
PROVIDER NAME)/the doctors or other health professionals at (US3A
PROVIDER NAME)].
NAMESPCL

US37E1

verbatim text

First, what is the name of the specialist [you/(SP)] saw most often since
(TODAY'S MONTH AND YEAR-12 MONTHS)?

(01) continuous answer

US37E2 - SEXSPCL

(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED

US37F - KNOWSPCL

[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE
DIRECTORY, APPOINTMENT CARD, ETC., FOR COMPLETE
INFORMATION.]

SEXSPCL

US37E2

code one

Is [(US37E1 PROVIDER NAME)/the specialist you saw most often since
(TODAY'S MONTH AND YEAR-12 MONTHS)] a male or female?

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

SHOW CARD US5
[IF NEEDED: This question is about the last twelve months, that is since
(TODAY'S MONTH AND YEAR - 12 MONTHS).]

KNOWSPCL

US37F

code one

The next questions ask about care [you/(SP)] received from the specialist
[you/he/she] saw most often in the last twelve months outside the [office of
(US5A PROVIDER NAME)/the doctors or other health professionals at (US3A
PROVIDER NAME)].
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], does
[he/she/he or she] seem to know enough information about [your/his/her] medical
history?

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) Don't Know
(-9) Refused

US37G - RPTINFO

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US4
RPTINFO

US37G

code one

(01) NEVER
(02) SOMETIMES
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often [do (03) USUALLY
you/does (SP)] have to repeat information that [you/he/she] [have/has] already
(04) ALWAYS
given to [(US5A PROVIDER NAME)/the doctors or other health professionals at (-8) Don't Know
(US3A PROVIDER NAME)]?
(-9) Refused

BOX US6

routing

IF PP1A-PROVYR= 01/YES, GO TO PP49-TESTRSLT.
ELSE GO TO BOX US7.

BOX US6

SHOW CARD US4

TESTRSLT

PP49

code one

The next questions ask about care [you/(SP)] received from the specialist
[you/he/she] saw most often in the since (TODAY'S MONTH AND YEAR-12
MONTHS) outside the [office of (US5A PROVIDER NAME)/the doctors or other
health professionals at (US3A PROVIDER NAME)].
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often
does [he/she/he or she] seem to know [your/(SP)'s] important test results from
other providers?

HOSADMIT

HOSFLWUP

HOSMED

PP50

PP51

PP52

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), [were you/was (SP)]
admitted to a hospital overnight or longer?

(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused

PP50-HOSADMIT

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

(01) PP51- HOSFLWUP
(02) PP58- MNGCARE
(-8) PP58- MNGCARE
(-9) PP58- MNGCARE

yes/no

(01) YES
After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME)/the
(02) NO
medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their]
(-8) DON'T KNOW
office contact [you/him/her] to see how [you were/he was/she was] doing?
(-9) REFUSED

PP52- HOSMED

yes/no

(01) YES
After [your/(SP)'S] most recent hospital stay, [were you/was (SP)] prescribed any (02) NO
medicines?
(-8) DON'T KNOW
(-9) REFUSED

(01) PP53- HOSFOLLOWUP
(02) PP54- HOSINSTU
(-8) PP54- HOSINSTU
(-9) PP54- HOSINSTU

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

HOSFOLLOWUP

HOSINSTU

PP53

PP54

yes/no

After (your/(SP)'s)] most recent hospital stay, did [(US5A PROVIDER NAME)/the
medical providers at (US3A PROVIDER NAME)] or someone in [his/her/their]
office contact [you/SP] to check if [you were/he was/she was ] able to follow
instructions about any medicines [you were/he was/she was] prescribed?

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

PP54- HOSINSTU

yes/no

After (your/(SP)'s] most recent hospital stay, (were you/was he/was she] given
instructions about caring for [yourself/himself/herself] at home?

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

(01) PP55- INSTUEASY
(02) PP56- HOSINFO
(-8) PP56- HOSINFO
(-9) PP56- HOSINFO

SHOW CARD US5
INSTUEASY

HOSINFO

PP55

PP56

code one

code one

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
After [your/(SP)'s] most recent hospital stay, were the instructions [you were/(SP)
(03) NO
was] given easy to understand?
(-8) DON'T KNOW
(-9) REFUSED
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US5
After (your/(SP)'s) most recent hospital stay, did [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)] seem to know the
important information about this hospital stay?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US7

MNGCARE

PP58

code one

People sometimes need to manage their medical care by making appointments
with multiple providers, following their instructions, and taking medicines as
prescribed.
Using any number from 0 to 10, where 0 is hard and 10 is easy, what number
would you use to rate how easy it was for [you/(SP)] to manage [your/his/her]
medical care since (TODAY'S MONTH AND YEAR-12 MONTHS)?

PP56- HOSINFO

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED

PP58-MNGCARE

(00) 0 HARD TO MANAGE
(01) 1
(02) 2
(03) 3
(04) 4
(05) 5
(06) 6
(07) 7
(08) 8
(09) 9
(10) 10 EASY TO MANAGE

PP59- ONEDOC PP58A-DOCCARE

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

DOCCARE

PP58A

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need help
from [anyone in (US5A PROVIDER NAME)'s office/the doctors or other health
professionals at (US3A PROVIDER NAME)] to manage [your/his/her] care
among these different providers and services?

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

(01) PP58B-GETHELP
(02) PP59-ONEDOC
(-8) PP59-ONEDOC
(-9) PP59-ONEDOC

SHOW CARD US5
GETHELP

PP58B

code one

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get the help
(03) NO
[you/he/she] needed from [(US5A PROVIDER NAME)'s office/the doctors or
(-8) DON'T KNOW
other health professionals at (US3A PROVIDER NAME)] to manage
(-9) REFUSED
[your/his/her] care among these different providers and services?

SHOW CARD US5
ONEDOC

PP59

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider
who knew about all [your/(SP)'s] medical care needs?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US5

PRVNOMED

PP60

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider
who knew about all the medicines [you were/(SP) was] taking?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

BOX US7

routing

GO TO US37I- NOTAVAIL

PP59-ONEDOC

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED

PP60- PRVNOMED

(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX US7

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

NOTAVAIL

COMPUSE

US37I

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), when getting care for a
medical problem, was there ever a time when test results, medical records, or
reasons for referrals were not available at the time of [your/(SP)’s] scheduled
doctor or other health professional appointment?

BOX EHR1

routing

IF US1-PLACEPAR=1, GO TO EHR2-COMPUSE,
ELSE GO TO BOX USEND.

EHR2

yes/no

The next few questions will help us to understand how (US5A PROVIDER
NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)
use(s) a computer during [your/(SP)'s] office visit. Please answer the questions
that follow based upon where [you go/(SP) goes] for medical care most of the
time.
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER
NAME)] use a computer during [your/(SP)'s] office visit?

EMEDREC

US37K

yes/no

Many health care providers are beginning to use electronic or computer-based
medical records instead of using paper-based records. When [you visit/(SP)
visits] [(US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME)] [does he or she/do they] generally enter
[your/(SP)'s] health information into a computer while [you are/(SP) is] present?

(01) YES
(02) NO
(03) NOT APPLICABLE
(04) NOT SURE
(-9) Refused

US37K - EMEDREC
BOX EHR1

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

(01) US37K - EMEDREC
(02) BOX EHR2
(-8) BOX EHR2
(-9) BOX HER

(01) YES
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: An “electronic health record” is an electronic version
(-9) Refused
of a patient’s medical history maintained by a provider over time. It automates
the way in which doctors can access patient health information. "Health
Information" includes information such as symptoms, vital signs, test results, or
prescribed medicines.]

BOX USEND
EHR3-COMPSHW

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

COMPSHW

COMPHLTH

COMPREC

yes/no

Is the examination room set up so that (US5A PROVIDER NAME)/the doctors or
(01) YES
other health professionals at (US3A PROVIDER NAME) can easily show
(02) NO
[you/(SP)] information on the computer screen?

(01) EHR4-COMPHLTH
(02) BOX EHR2
(-8) BOX EHR2
(-9) BOX EHR2

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals
at (US3A PROVIDER NAME)] use the computer to show [you your/(SP) his/(SP)
her] health information during [your/his/her] visit, such as trends in blood
pressure reading, height, weight and body mass index, previous lab results, xrays/images, immunizations or medications?

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

(01) EHR5-COMPREC
(02) BOX EHR2
(-8) BOX EHR2
(-9) BOX EHR2

EHR5

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals
at (US3A PROVIDER NAME)] use the computer to show [you/(SP)]
recommendations for preventive health screenings or other medical services?

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

BOX EHR2

BOX EHR2

routing

IF US1-PLACEPAR=1, GO TO EHR6-COMPRD,
ELSE GO TO BOX EHR3.

EHR3

EHR4

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

COMPRD

COMPINF

COMPACC

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals
at (US3A PROVIDER NAME)] read back to [you/(SP)] information that [you
have/(SP) has] given during [your/(SP)'s] visit that is being put into [your/(SP)'s]
medical record?

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

EHR7-COMPINF

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals
at (US3A PROVIDER NAME)] send [you/(SP)] health information electronically,
such as information about [your/(SP)'s] medications, exercise plans, dietary
advice, etc.?

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

EHR8-COMPACC

EHR8

yes/no

[Does (US5A PROVIDER NAME)'s/Do the doctors or other health professionals
at (US3A PROVIDER NAME)]'s office give [you/(SP)] access through
[your/(SP)'s] own computer or smart phone to parts or all of [your/(SP)'s]
electronic medical record (such as a list of [your/(SP)'s] medications, lab results,
x-ray reports, office notes) through a “patient portal” or other electronic system?

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

BOX EHR3

BOX EHR3

routing

IF EHR2-COMPUSE=(01) YES, GO TO EHR9-COMPHLP,
ELSE GO TO BOX USEND

EHR6

EHR7

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

COMPHLP

EHR9

list

(01) STRONGLY AGREE
(02) AGREE
SHOW CARD US6
(03) DISAGREE
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A (04) STRONGLY DISAGREE
(05) NOT APPLICABLE
PROVIDER NAME) use of the computer during [my/(SP)'s] visit is helpful to
(-8) Don't Know
[me/(SP)].
(-9) Refused

EHR9-COMPDIST

(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A (04) STRONGLY DISAGREE
PROVIDER NAME) use of the computer during [my/(SP)'s] visit distracts him/her (05) NOT APPLICABLE
(-8) Don't Know
from paying attention to [me/(SP)].
(-9) Refused

EHR9-COMPATT

(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A (04) STRONGLY DISAGREE
(05) NOT APPLICABLE
PROVIDER NAME) use of the computer during [my/(SP)'s] visit distracts
(-8) Don't Know
[me/(SP)] from paying attention to the clinician.
(-9) Refused

EHR10-COMPTM

SHOW CARD US6
COMPDIST

EHR9

list

SHOW CARD US6
COMPATT

EHR9

list

SHOWCARD US8

COMPTM

EHR10

code one

The amount of time during the visit that (US5A PROVIDER NAME)/the doctors
or other health professionals at (US3A PROVIDER NAME) spend(s) on the
computer seems:
much more than it should be, somewhat more than it should be, about what it
should be, somewhat less than it should be, or no opnion?

(01) Much more than it should be
(02) Somewhat more than it should be
(03) About what it should be
(04) Somewhat less than it should be
(05) Much less than it should be
(06) No opinion

BOX USEND

USQ - USUAL SOURCE OF CARE

2020 MCBS Community Questionnaire

NUSNOTSK

NUSMOVIN

US39

US39

list

list

NUSAVAIL

US39

list

USWHYNAV

US42

code one

USWHYNO1

US42

verbatim text

NUSDIFFP

US43

list

NUSTOOFR

US43

list

NUSTOOEX

US43

list

BOX USEND

routing

I am going to read some reasons that people have given for not having a usual
source of health care. For each one, please tell me whether or not it is a reason
(01) YES
[you do/(SP) does] not have a usual place for health care.
(02) NO
(-8) DON'T KNOW
There is no reason to have a usual source of health care because [you/(SP)]
(-9) REFUSED
seldom or never [get/gets] sick. [Is that a reason [you do/(SP) does] not have a
usual source of health care?]

(01) YES
[You/(SP)] recently moved into the area. [Is that a reason [you do/(SP) does] not (02) NO
have a usual source of health care?]
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
[Your/(SP’s)] usual source of health care in this area is no longer available. [Is
(02) NO
that a reason [you do/(SP) does] not have a usual source of health care?]
(-8) DON'T KNOW
(-9) REFUSED
(01) PREVIOUS DOCTOR RETIRED
(02) PREVIOUS DOCTOR DIED
(03) PREVIOUS DOCTOR MOVED
(04) SP MOVED
Why is [your/(SP’s)] usual source of health care no longer available?
(05) PREVIOUS DR/PLACE TOO FAR AWAY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
OTHER (SPECIFY)
Thinking about other possible reasons that people have for not having a usual
source of health care, please tell me if this statement applies to [you/(SP)]:
[You like/(SP) likes] to go to different places for different health care needs. [Is
that a reason [you do/(SP) does] not have a usual source of health care?]

US39 - NUSAVAIL
(01) US42 - USWHYNAV
(02) US43 - NUSDIFFP
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
(01) US43 - NUSDIFFP
(02) US43 - NUSDIFFP
(03) US43 - NUSDIFFP
(04) US43 - NUSDIFFP
(05) US43 - NUSDIFFP
(91) US42 - USWHYNO1
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP

(01) CONTINUOUS ANSWER

US43 - NUSDIFFP

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

US43 - NUSTOOFR

(01) YES
The places where [you/(SP)] can receive health care are too far away. [Is that a (02) NO
reason [you do/(SP) does] not have a usual source of health care?]
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
The cost of health care is too expensive. [Is that a reason [you do/(SP) does]
(02) NO
not have a usual source of health care?]
(-8) DON'T KNOW
(-9) REFUSED
GO TO END.

US39 - NUSMOVIN

US43 - NUSTOOEX

BOX USEND