CMS-P-0015A Home Health

HHQ- HOME HEALTH UTILIZATION

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

Routing

HOME HEALTH UTILIZATION QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007, C010
SPALIVE=ALL
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in (C001, C002, C004, C005, C006, C007, C010) administer after IUQ.
SHOW CARD HH1
(At the time of the last interview, [you/(SP)] indicated that [you/(she/he)] had been helped at home by a health or
medical professional.)
HHPRPROF

HH1

yes/no

(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP. DO NOT
[(Since/since) (REFERENCE DATE/UTILDATE)/(Between/between) (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)], [have you been/has (SP) been/was (SP)] helped at home DISPLAY. DATA EDITING ONLY.
(-8) DON'T KNOW
by any (other) health or medical professionals, such as those listed on this card? (This may include health or
(-9) REFUSED
medical professionals reported in prior interviews.)

(01) HH4-PROFWORK
(02) HH18 - HHPRFRND
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND

[Health professionals include nurse (visiting nurse, private duty nurse, etc.), doctor, social worker, therapist, hospice
worker, home health aides, and those who provide homemaker services.]
PROFWORK

Does this health or medical professional work for a place or organization?
HH4

code one
[PROBE: Or does this health or medical professional work for himself/herself?]
What is the name of the home health place or organization who helped [you/(SP)] at home [since (REFERENCE
DATE/UTILDATE)/between (PREVIOUS ROUND INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)]?

PROVIDER_HHP
HH5
ORG

roster

(01) WORKS FOR ORGANIZATION
(02) WORKS FOR SELF
(-8) DON'T KNOW
(-9) REFUSED

(01) HH5-PROVIDER_HHPORG
(02) HH2-PROVIDER_HHP
(-8) HH2-PROVIDER_HHP
(-9) HH2-PROVIDER_HHP

(01) CONTINUOUS ANSWER

[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
[PROBE: Who would (you/SP) call if the home health provider did not show up?]
1. [PROVIDER 1]
2. [PROVIDER 2]
ADD OR SELECT ONLY ONE PROVIDER.
…
N. [PROVIDER N]
ENTER THE NAME OF THE PLACE OR ORGANIZATION RATHER THAN AN INDIVIDUAL PROVIDER.
N+1. ADD ANOTHER
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING AN N+2. NEED TO EDIT SPELLING OF EXISTING
PROVIDER
EVENT WITH THAT PROVIDER.
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
[DO NOT ADD A NEW ROSTER ENTRY IF A DIFFERENT PERSON CAME FROM AN ORGANIZATION ALREADY NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
LISTED ON THE ROSTER.]

(01-N) BOX HH1AAA
(N+1) PROVNAME-HH5
(N+2) CHNGSPL-CHNGSPL
IF EXISTING PROVIDER SELECTED, GO TO BOX
HH1AAA.
ELSE IF "ADD ANOTHER" SELECTED, GO TO
PROVNAME-HH5
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.

[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
ENTER THE NAME OF THE PLACE OR ORGANIZATION RATHER THAN AN INDIVIDUAL PROVIDER.

PROVNAME

HH5

verbatim

[DO NOT ADD A NEW ROSTER ENTRY IF A DIFFERENT PERSON CAME FROM AN ORGANIZATION ALREADY
LISTED ON THE ROSTER.]

BOX HH1AAA

YOU CAN CONSULT THE RESPONDENT’S STATEMENTS AND APPOINTMENT CARDS TO ENSURE THE
PROVIDER NAME IS ENTERED CORRECTLY.
NAME:

WHICH PROVIDER IS MISSPELLED?

CHNGSPL

CHNGSPL

roster

THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."

[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]

CRCTSPL-CRCTSPL

ONLY SELECT A PROVIDER IF YOU ARE CURRENTLY ENTERING AN EVENT WITH THAT PROVIDER. IF YOU
ARE NOT CURRENTLY ENTERING AN EVENT WITH A MISSPELLED PROVIDER, BACK UP TO SELECT OR
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ADD THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.

Page 1 of 6

HHQ- HOME HEALTH UTILIZATION

2020 MCBS Community Questionnaire

Variable Name

CRCTSPL

MR Screen Name Question Type

CRCTSPL

verbatim

Question Text/Description
WHAT IS THE CORRECT SPELLING OF THIS PROVIDER'S NAME?
THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]

Code List

Routing

(01) [Continuous Answer]

BOX HH1AAA

(01) CONTINUOUS ANSWER

(01-N) BOX HH1AAA
(N+1) PROVNAME-HH2
(N+2) CHNGSPL-CHNGSPL

NAME:

What is the name of the health professional who helped [you/(SP)] at home [since (REFERENCE
DATE/UTILDATE)/between (PREVIOUS ROUND INTERVIEW DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)]?
PROVIDER_HHP HH2

roster

[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
ENTER NAME OF PERSON WHO HELPED. DO NOT ENTER THE NAME OF PLACE OR ORGANIZATION.
…
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING AN N. [PROVIDER N]
EVENT WITH THAT PROVIDER.
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.

IF EXISTING PROVIDER SELECTED, GO TO BOX
HH1AAA
ELSE IF "ADD ANOTHER" SELECTED, GO TO
PROVNAME-HH2
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.

[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
ENTER NAME OF PERSON WHO HELPED. DO NOT ENTER THE NAME OF PLACE OR ORGANIZATION.
PROVNAME

HH2

verbatim

BOX HH1AAA

YOU CAN CONSULT THE RESPONDENT’S STATEMENTS AND APPOINTMENT CARDS TO ENSURE THE
PROVIDER NAME IS ENTERED CORRECTLY.
NAME:

WHICH PROVIDER IS MISSPELLED?

CHNGSPL

CHNGSPL

roster

THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."

[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]

CRCTSPL-CRCTSPL

ONLY SELECT A PROVIDER IF YOU ARE CURRENTLY ENTERING AN EVENT WITH THAT PROVIDER. IF YOU
ARE NOT CURRENTLY ENTERING AN EVENT WITH A MISSPELLED PROVIDER, BACK UP TO SELECT OR
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ADD THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.

WHAT IS THE CORRECT SPELLING OF THIS PROVIDER'S NAME?

CRCTSPL

CRCTSPL

verbatim

THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]

(01) [Continuous Answer]

BOX HH1AAA

NAME:

BOX HH1AAA

routing

IF (HOME HEALTH PROVIDER WAS ADDED AT HH2 OR HH5) OR (AN EXISTING PROVIDER WAS SELECTED
AT HH2 OR HH5 THAT WAS NOT ASSOCIATED WITH A HOME HEALTH EVENT), GO TO HH3 - PROVSPEC.
ELSE GO TO BOX HH1BBB.

Page 2 of 6

HHQ- HOME HEALTH UTILIZATION

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

Question Text/Description

HH3

code one

PROVSPOS

HH3

text

OTHER MEDICAL PROVIDER (SPECIFY)

routing

IF HH4 -PROFWORK = 1/Works for Organization, SET HOME HEALTH PROVIDER FOR THIS VISIT TO THE
HOME HEALTH ORGANIZATION SELECTED AT HH5, AND GO TO HH6 - HHPLACE.
ELSE SET HOME HEALTH PROVIDER FOR THIS VISIT TO THE PROVIDER SELECTED AT HH2, HH19, ST27
OR NS27, AND GO TO BOX HH1BB.

BOX HH1AA

HHPLACE

HH6

code one

PROVIDER NAME: (PROVIDER NAME)
What kind of place or organization is (PROVIDER NAME)?

(01) MANAGED CARE PLAN (SUCH AS HMO)
(02) MEAL PROGRAM (SUCH AS MEALS ON
WHEELS)
(03) VISITING NURSE ASSOCIATION
(04) HOME HEALTH AGENCY
(05) HOSPITAL
(06) PRIVATE PHYSICIAN/GROUP PRACTICE
(07) HOSPICE
(08) REHABILITATION OR SPORTS MEDICINE
THERAPY
(09) LOCAL GOVERNMENT ORGANIZATION
(10) CHURCH OR COMMUNITY ORGANIZATION
(11) ASSISTED LIVING/RETIREMENT HOME
(91) OTHER (SPECIFY)
(-8) DON'T KNOW
(-9) REFUSED

HHPLACOS

HH6

text

OTHER (SPECIFY)

(01) CONTINUOUS ANSWER

BOX HH1BBB

routing

SET HOME HEALTH PROVIDER FOR THIS VISIT TO THE PROVIDER SELECTED AT HH2, HH5, OR HH19.
IF TYPE OF HOME HEALTH PROVIDER ORGANIZATION IS A MEAL PROGRAM, GO TO HH7 - OTHMEALS.
ELSE GO TO BOX HH1BB.

HH7

yes/no

[Between (REFERENCE DATE/UTILDATE) and (today/DATE OF DEATH/ DATE OF
INSTITUTIONALIZATION/ENDUTILD)], did (PROVIDER NAME) provide any services to [you/(SP)] other than
delivering meals?

OTHMEALS

Routing

(01) DENTIST/DENTAL PROVIDER
(02) MEDICAL DOCTOR
(03) AUDIOLOGIST
(04) CHIROPRACTOR
(05) CLINICAL SOCIAL WORKER
(06) DIETITIAN-NUTRITIONIST
(07) HEARING THERAPIST
(08) HOME HEALTH/HEALTH AIDE
(09) HOMEMAKER
(10) HOSPICE WORKER
(11) I.V. THERAPIST
(12) NURSE (RN)
(13) NURSE PRACTITIONER
(14) NURSE'S AIDE
(15) OCCUPATIONAL THERAPIST (OT)
(16) OPTOMETRIST (OD)
What kind of health professional [is (PROVIDER NAME)/did [you/(SP)] see from (PROVIDER NAME)]?
(17) OSTEOPATH (DO)
(18) PARAMEDIC
[SELECT THE RESPONSE CATEGORY FOR A GIVEN SPECIALTY ONLY IF THE RESPONDENT SPECIFICALLY (19) PHYSICAL THERAPIST (PT)
(01)-(34), (-8), (-9) BOX HH1AA
NAMES THE LISTED SPECIALTY OR MENTIONS THE WORDS OR INITIALS IN PARENTHESES FOLLOWING
(91) HH3 - PROVSPOS
(20) PHYSICIAN'S ASSISTANT
THAT PROVIDER SPECIALTY. IF THE RESPONDENT NAMES A MEDICAL SPECIALTY NOT LISTED BELOW,
(21) PODIATRIST (FOOT DOCTOR)
BUT LISTED ON MPQ JOB AID 1, SUCH AS ‘CARDIOLOGY,’ SELECT 'MEDICAL DOCTOR.']
(22) PSYCHOLOGIST
(23) RESPIRATORY THERAPIST
(24) SOCIAL/CASE WORKER
(25) SPEECH THERAPIST
(26) THERAPIST (MENTAL HEALTH)
(27) X-RAY TECHNICIAN
(28) LICENSED PRACTICAL NURSE (LPN)
(29) ACUPUNCTURIST
(30) HOMEOPATH
(31) MASSAGE THERAPIST
(32) NATUROPATH
(33) LICENSED PROFESSIONAL COUNSELOR [LPC]
(34) LAB TECHNICIAN
(91) OTHER MEDICAL PROVIDER SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED

PROVSPEC

BOX HH1AA

Code List

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

(01) BOX HH1BB
(02) BOX HH1BBB
(03) BOX HH1BB
(04) BOX HH1BB
(05) BOX HH1BB
(06) BOX HH1BB
(07) BOX HH1BB
(08) BOX HH1BB
(09) BOX HH1BB
(10) BOX HH1BB
(11) BOX HH1BB
(91) HH6 - HHPLACOS
(-8) BOX HH1BB
(-9) BOX HH1BB

BOX HH1BB

Page 3 of 6

HHQ- HOME HEALTH UTILIZATION

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

Question Text/Description

BOX HH1BB

routing

IF TYPE OF HOME HEALTH PROVIDER IS A MEAL PROGRAM THAT DID NOT PROVIDE ANY OTHER
SERVICES BESIDES MEALS, GO TO BOX HH3.
ELSE IF (HOME HEALTH PROVIDER IS A FRIEND OR RELATIVE) OR (TYPE OF HOME HEALTH PROVIDER IS
A LOCAL GOVERNMENT, CHURCH OR COMMUNITY ORGANIZATION), GO TO HH11-EVENT.
ELSE GO TO BOX HH1.

BOX HH1

routing

IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A. IN THE CURRENT ROUND OR ANY
PREVIOUS ROUND) AND (IF THIS PROVIDER IS ASSOCIATED WITH V.A. IS UNKNOWN), GO TO HH8 VAPLACE.
ELSE GO TO BOX HH1A.

HH8

yes/no

Is [(PROVIDER NAME) associated with/(PROVIDER NAME)] a Department of Veterans Affairs, or V.A., facility?

BOX HH1A

routing

IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND) AND (IF THIS
PROVIDER IS ASSOCIATED WITH A MANAGED CARE PLAN IS UNKNOWN), GO TO HH10A - HMOASSOC.
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND) AND (THIS
PROVIDER IS NOT ASSOCIATED WITH A MANAGED CARE PLAN), GO TO HH10B - HMOREFER.
ELSE GO TO HH11-EVENT.

HMOASSOC

HH10A

yes/no

HMOREFER

HH10B

yes/no

VAPLACE

Code List

Routing

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

BOX HH1A

Is (PROVIDER NAME) associated with [your/(SP’s)] [READ MANAGED CARE PLAN NAME(S) BELOW] plan?

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

(01) HH11- EVENT
(02) HH10B - HMOREFER
(-8) HH10B - HMOREFER
(-9) HH10B - HMOREFER

[Were you/Was (SP)] referred to (PROVIDER NAME) by [READ MANAGED CARE PLAN NAME(S) BELOW]?
[INCLUDE REFERRALS BY THE RESPONDENT’S PRIMARY CARE PHYSICIAN (PCP).]

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

HH11 -EVENT

(01) [Continuous answer.]

HH12-HPADD

(01) ADD ANOTHER
(02) ALL DONE

(01) HH11 -EVENT
(02) HH13-NEEDNURS

(01) YES, AT LEAST ONE
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HH14 - NEEDMEAL

(01) YES, AT LEAST ONE
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HH15 - NEEDCARE

When did [you/(SP)] see [(PROVIDER NAME)/(someone from (PROVIDER NAME))]? Please tell me all the dates
[since (REFERENCE DATE/UTILDATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)].
ENTER ALL DATES.
EVENT

HH11

roster

[IF THE RESPONDENT SAW THE SAME PROVIDER TWICE ON THE SAME DAY, ENTER THE DATE ONLY
ONCE.]
IF R HAD 5 OR MORE VISITS FROM THIS PROVIDER DURING THIS REFERENCE PERIOD, SELECT "REPEAT
VISITS" AND LEAVE THE DAY FIELD BLANK. ENTER EACH MONTH SEPARATELY.
HAVE ALL DATES BEEN ENTERED?

HPADD

HH12

choose one
[DISPLAY ALL EVENTS ASSOCIATED WITH THIS PROVIDER]
SHOW CARD HH2

NEEDNURS

HH13

yes/no

(Generally speaking, did/Generally speaking, does)[(PROVIDER NAME)/someone from (PROVIDER NAME)] help
[you/(SP)] by giving any medical or nursing treatment, such as the things shown on this card? ["MEDICAL OR
NURSING TREATMENT" MEANS SUCH THINGS AS APPLYING STERILE BANDAGES OR DRESSINGS, GIVING
MEDICATIONS, TAKING BLOOD PRESSURE, GIVING SHOTS OR INJECTIONS.]
[PROBE: We just need to know in general.]
SHOW CARD HH3

NEEDMEAL

HH14

yes/no

(Generally speaking, did/Generally speaking, does) [(PROVIDER NAME)/someone from (PROVIDER NAME)] help
with [your/(SP’s)] daily needs by doing things, such as the ones shown on this card? [HELP WITH DAILY NEEDS
MEANS HELP IN USING THE TELEPHONE, DOING HOUSEWORK, PREPARING MEALS.]
[PROBE: We just need to know in general.]
SHOW CARD HH4

NEEDCARE

HH15

yes/no

(01) YES, AT LEAST ONE
(Generally speaking, did/Generally speaking, does) [(PROVIDER NAME)/someone from (PROVIDER NAME)] help
(02) NO
with [your/(SP’s)] personal care by doing things such as those shown on this card? [HELP WITH PERSONAL CARE
(-8) DON'T KNOW
MEANS HELP WITH BATHING, SHOWERING, DRESSING, EATING, WALKING, USING THE TOILET.]
(-9) REFUSED

BOX HH2

[PROBE: We just need to know in general.]

Page 4 of 6

HHQ- HOME HEALTH UTILIZATION

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

Question Text/Description

BOX HH2

IF EXISTING PROVIDER SELECTED at HH2-PROVIDER_HHP, HH5-PROVIDER_HHPORG, HH19PROVIDER_HHF, or ST13-PROVIDER_STDATE, GO TO BOX HH3.
ELSE IF "ADD ANOTHER" SELECTED at HH2-PROVIDER_HHP, HH5-PROVIDER_HHPORG, HH19PROVIDER_HHF, or or ST13-PROVIDER_STDATE, GO TO HH15A-ATNDPHYS.

routing

To be eligible for Medicare home health services, a beneficiary must be under the care of a physician who decides
home health services are necessary.
What is the complete name of the physician who determined that [you/SP] should receive home health services?

Code List

Routing

[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]

(01) continuous answer
(996) NOT APPLICABLE/RESPONDENT DOES NOT
BOX HH3
[IF THE RESPONDENT DOES NOT RECEIVE HOME HEALTH SERVICES THROUGH MEDICARE, SELECT NOT RECEIVE HOME HEALTH SERVICES THROUGH
MEDICARE
APPLICABLE. IF THE RESPONDENT DOES NOT KNOW THE NAME OF THE PHYSICIAN, SELECT DON'T
(-8) Don't Know
KNOW.]
(-9) Refused
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ETC., FOR COMPLETE INFORMATION.]
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.
[IF NEEDED: This physician can also be referred to as the attending physician.]

ATNDPHYS

HHPMORE

HHPOMORE

HH15A

text

BOX HH3

routing

IF CURRENTLY ADMINISTERING ST, GO TO BOX ST23B.
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS33.
ELSE IF CURRENTLY ASKING ABOUT HOME HEALTH FRIENDS OR FAMILY, GO TO HH28-HHFMORE.
ELSE IF HOME HEALTH PROVIDER WORKED FOR SELF, GO TO HH16 - HHPMORE.
ELSE GO TO HH17 - HHPOMORE.

HH16

yes/no

[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you been/has (SP) been/was (SP)] helped at home by any other
health professionals?

HH17

yes/no

Other than the persons who (have) visited [you/(SP)] from (PROVIDER NAME) [or from the other(s) we’ve talked
about], [have you been/has (SP) been/was (SP)] helped at home by any other health professionals [since
(REFERENCE DATE/UTILDATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)]?

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

(01)HH4 -PROFWORK
(02) HH18 - HHPRFRND
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND

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

(01) HH4-PROFWORK
(02) HH18 - HHPRFRND
(-8) HH18 - HHPRFRND
(-9) HH18 - HHPRFRND

(01) YES
(02) NO
(03) INDICATED YES BY DATAPREP DO NOT
DISPLAY. DATA EDITING ONLY.
(-8) DON'T KNOW
(-9) REFUSED

(01) HH19 - PROVIDER_HHF
(02) BOX HH7
(03) DO NOT DISPLAY. DATA EDITING ONLY.
(-8) BOX HH7
(-9) BOX HH7

[DON’T INCLUDE ANY OTHER PERSONS COMING FROM THE SAME ORG/ AGENCY LISTED BELOW]
SHOW CARD HH5
(At the time of the last interview, [you/(SP)] indicated that, because of health problems, [you/(she/he)] had received
personal care or help at home with daily needs from a person who did not live with [you/(her/him)].)
HHPRFRND

HH18

yes/no

(Besides what you have already talked about, [(Since/since) (REFERENCE DATE/UTILDATE)/(Between/between)
(REFERENCE DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION/ENDUTILD)], because of health
problems [have you/has (SP)/did (SP)] (received/receive) any personal care or help at home with daily needs from
(any other) persons who (do/did) not live with (you/him/her), including friends, neighbors, or relatives? (This may
include friends, neighbors, or relatives reported in prior interviews.)

(01) CONTINUOUS ANSWER
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
[SELECT OR ADD ONLY ONE PERSON. DO NOT ENTER A PERSON WHO LIVES WITH THE SP.]
…
ONLY SELECT "NEED TO EDIT SPELLING OF EXISTING PROVIDER" IF YOU ARE CURRENTLY ENTERING AN N. [PROVIDER N]
EVENT WITH THAT PROVIDER.
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02
Who helped [you/(SP)]? What is the name of the person who helped (you/him/her)?
ENTER NAME OF PERSON WHO HELPED.
PROVIDER_HHF HH19

roster

PROVNAME

verbatim

(01-N) BOX HH3AA
(N+1) PROVNAME-HH19
(N+2) CHNGSPL-CHNGSPL
IF EXISTING PROVIDER SELECTED, GO TO BOX
HH3AA
ELSE IF "ADD ANOTHER" SELECTED, GO TO
PROVNAME-HH19
ELSE IF "NEED TO EDIT SPELLING OF EXISTING
PROVIDER" SELECTED, GO TO CHNGSPLCHNGSPL.

[PROVIDER LOOKUP CALLED FROM THIS SCREEN]
HH19

ENTER NAME OF PERSON WHO HELPED. DO NOT ENTER THE NAME OF THE PLACE OR ORGANIZATION.

BOX HH3AA

NAME:

Page 5 of 6

HHQ- HOME HEALTH UTILIZATION

2020 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

Question Text/Description

WHICH PROVIDER IS MISSPELLED?

CHNGSPL

CHNGSPL

roster

THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."

Code List
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
…
N. [PROVIDER N]

Routing

CRCTSPL-CRCTSPL

ONLY SELECT A PROVIDER IF YOU ARE CURRENTLY ENTERING AN EVENT WITH THAT PROVIDER. IF YOU
ARE NOT CURRENTLY ENTERING AN EVENT WITH A MISSPELLED PROVIDER, BACK UP TO SELECT OR
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
ADD THE PROVIDER THE RESPONDENT SAW DURING THIS EVENT.
NAME FOR ALL PROVIDERS WHERE PROVNUM>02.

WHAT IS THE CORRECT SPELLING OF THIS PROVIDER'S NAME?

CRCTSPL

CRCTSPL

verbatim

THIS SCREEN IS ONLY FOR CORRECTING MISSPELLINGS. TO ADD A NEW PROVIDER, BACK UP AND
SELECT "ADD ANOTHER."
[DISPLAY PROVIDER SELECTED AT CHNGSPL-CHNGSPL]

(01) [Continuous Answer]

BOX HH3AA

(01) BOX HH1AA
(02) HH21 - HHFRELAT
(-8) BOX HH1AA
(-9) BOX HH1AA

NAME:

HHFTYPE

BOX HH3AA

routing

IF (HOME HEALTH PROVIDER WAS ADDED AT HH19) OR (AN EXISTING PROVIDER WAS SELECTED AT
HH19 THAT WAS NOT ASSOCIATED WITH A HOME HEALTH EVENT), GO TO HH20 - HHFTYPE.
ELSE GO TO BOX HH1BBB.

HH20

code one

Is (PROVIDER NAME) a friend, neighbor, or a relative?

(01) FRIEND OR NEIGHBOR
(02) RELATIVE
(-8) DON'T KNOW
(-9) REFUSED

HHFRELAT

HH21

code one

How is (PROVIDER NAME) related to [you/(SP)]?
[CLASSIFY ANY “STEP” RELATIONSHIP WITH THE RELATED “NON-STEP” RELATIONSHIP (E.G., STEPDAUGHTER = DAUGHTER).]

(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

HHFRELOS

HH21

text

OTHER (SPECIFY)

(01) CONTINUOUS ANSWER

BOX HH1AA

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

(01) HH19 - PROVIDER_HHF
(02) BOX HH7
(-8) BOX HH7
(-9) BOX HH7

HHFMORE

HH28

yes/no

[Since (REFERENCE DATE/UTILDATE)/Between (REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION/ENDUTILD)], [have you/has (SP)/did (SP)] (received/receive) personal care or help at
home with daily needs from any other persons who (do/did) not live with (you/him/her)?

BOX HH7

routing

GO TO MPQ.

(02) BOX HH1AA
(03) BOX HH1AA
(04) BOX HH1AA
(05) BOX HH1AA
(06) BOX HH1AA
(07) BOX HH1AA
(08) BOX HH1AA
(09) BOX HH1AA
(10) BOX HH1AA
(11) BOX HH1AA
(12) BOX HH1AA
(13) BOX HH1AA
(14) BOX HH1AA
(51) BOX HH1AA
(52) BOX HH1AA
(53) BOX HH1AA
(54) BOX HH1AA
(55) BOX HH1AA
(56) BOX HH1AA
(57) BOX HH1AA
(91) HH21 - HHFRELOS
(-8) BOX HH1AA
(-9) BOX HH1AA

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