CMS-P-0015A interviewer Remarks

2019 MCBS Facility Instrument

Variable Name

IR-Interviewer Remarks

MR Screen Name Question Type

Question Text/Description

Code List

Routing

INTERVIEWER REMARKS SECTION SPECIFICATIONS
CRITERIA
(N/A)
PLACEMENT
(N/A)
BOX IRQBEG

routing

GO TO IRQ15 – MDSABST.

MDSABST

IRQ15

yes/no

DID YOU USE INFORMATION FROM AN MDS FOR ANY PART OF THIS INTERVIEW?

(00) NO
(01) YES

(00) IRQ3 - FUTUREF
(01) IRQ16 - MDSELEC

MDSELEC

IRQ16

yes/no

DID THIS FACILITY USE AN ELECTRONIC MDS?

(00) NO
(01) YES

(00) IRQ3 - FUTUREF
(01) IRQ17 - ELECHOW

(01) IRQ3 - FUTUREF
(02) IRQ3 - FUTUREF
(03) IRQ3 - FUTUREF
(04) IRQ3 - FUTUREF
(05) IRQ18 - ELECOTH

ELECHOW

IRQ17

select all

HOW DID YOU ACCESS THE ELECTRONIC MDS? SELECT ALL THAT APPLY.

(01) THE FACILITY PRINTED IT OUT FOR ME
(02) THE FACILITY STAFF READ THE MDS TO ME
(03) THE FACILITY GRANTED ME ACCESS TO THEIR
ELECTRONIC SYSTEM WITHOUT STAFF
SUPERVISION
(04) THE FACILITY GRANTED ME ACCESS TO THEIR
ELECTRONIC SYSTEM WITH STAFF SUPERVISION
(05) OTHER

ELECOTH

IRQ18

verbatim text

OTHER SPECIFY

(01) Continuous Answer

(01) IRQ3 - FUTUREF

FUTUREF

IRQ3

yes/no

ARE THERE ANY COMMENTS YOU WOULD LIKE TO MAKE ABOUT THE RESPONDENT(S) OR
INTERVIEWING SITUATION THAT COULD HELP THE NEXT INTERVIEWER COMPLETE THIS CASE?

(00) NO
(01) YES

(00) BOX IRQ1
(01) IRQ3OV - FUTURVB

FUTURVB

IRQ3OV

verbatim text

(01) Continuous Answer

(01) IRQ14 - ANYFIX

BOX IRQ1

routing

PLEASE RECORD THOSE NOTES HERE.
IF THERE ARE NO PREVIOUS ROUND DRIVING DIRECTIONS AVAILABLE, GO TO IRQ14B - DRIVE.
ELSE GO TO IRQ14C - DRIVCHNG.

IRQ14B

yes/no

ARE THERE ANY DRIVING INSTRUCTIONS THAT WOULD ASSIST AN INTERVIEWER NEXT ROUND IN
REACHING THE FACILITY?

(00) NO
(01) YES

(00) IRQEND - IRQENDCT
(01) IRQ14D - DRIVETXT

DO YOU NEED TO UPDATE OR CHANGE THE FOLLOWING DRIVING DIRECTIONS RECORDED IN THE LAST
ROUND?
(01) YES, REPLACE
(02) NO, KEEP THE SAME
PLEASE REMEMBER WHEN UPDATING OR CHANGING DRIVING DIRECTIONS, THE NEW TEXT WILL
(03) REMOVE DRIVING DIRECTIONS
REPLACE THE PREVIOUS TEXT.

DRIVE

DRIVCHNG

IRQ14C

yes/no

DRIVETXT

IRQ14D

verbatim text

IRQENDCT

IRQEND

code one

BOX IRQEND

routing

ENTER THE DRIVING DIRECTIONS.
YOU HAVE COMPLETED THE IRQ FOR (SP).
PRESS "1" TO RETURN TO CM-FIELD.
GO TO CM-FIELD.

(01) IRQ14D - DRIVETXT
(02) IRQEND - IRQENDCT
(03) IRQEND - IRQENDCT

(01) Continuous Answer

(01) IRQEND - IRQENDCT

(01) Continue

(01) BOX IRQEND

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