Attachment 60 Attachment 60 HC Other Medical Expense Section

SpecWriter Data

Form Version:

10/17/2017 4:06:21 PM

Report Type:

Full Detail

Project Database:
Language:

English

WESSQL6.MEPS_V2

Spec Label:

This is the cover page. Additional contents currently project specific.

OM - Page 1 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Rout

Full Detail Spec

BOX_00

Route Details:

(OM1005)

Item Type: Route

Type Class: If Then

01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60
02 Loop = LOOP_10
03 End Loop = END_LP10
04 Single Select = OM10, OM30, OM40, OM50, OM60, OM70
10 Multiple Select with Fill in Answer Text = OM80
23 Text Field = OM90
24 Information Screen = OM20
Grid Type 1 = OM80

BOX_10

Route Details:

(OM1010)

Item Type: Route

Type Class: If Then

Conte xt he a de r dis pla y ins tructions :
Dis pla y PERS .FULLNAME, PRND.BEGREFMM, PRND.BEGREFDD,
PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY
If PRND da te s a re mis s ing, us e RU da te s :
RUBEGMM, RUBEGDD, RUENDMM, RUENDDD

BOX_20

Route Details:

(OM1015)

Item Type: Route

Type Class: If Then

If pe rs on curre ntly looping on ha s be e n a s ke d EE40 or EE50, or ha s a re cord for
GLAS S ES OR CONTACT LENS ES cre a te d a t EV20, whe re EV20=8 go to BOX_30.
Othe rwis e , if RU me mbe r ha s not be e n a s ke d a bout gla s s e s /conta ct purcha s e s a t
EE40 or EE50 a nd doe s not ha ve GLAS S ES OR CONTACT LENS ES re cord cre a te d,
go to OM10.

OM - Page 2 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM10
Item Type:

(OM1020)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (
Context Header:

BLAISE NAME: Glasses
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

)

Show Card (

ArrayMax:

Max value:

)

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

Question Text:
Did {you/{PERSON}} purchase eyeglasses or contact lenses {since {START DATE}/between {START DATE} and {END
DATE}}?

Responses:

YES
NO
REFUSED
DON'T KNOW

Programmer
Instructions:

If OM10 coded ‘1’ (YES), create a record as OM-record for ‘GLASSES OR CONTACT
LENSES’, go to BOX_30.

Display
Instructions:

Testing/Editing
Notes:

BOX_30

Route Details:

1
2
RF
DK

BOX_30
BOX_30
BOX_30
BOX_30

(OM1025)
(OM1025)
(OM1025)
(OM1025)

Display ‘since {START DATE}’ if not round 5. Display ‘between {START DATE} and {END
DATE}’ if round 5.

Variable collected at MEPSSpring2018.OM_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main

(OM1025)

Item Type: Route

Type Class: If Then

If CA30_01-CA30_N ha s a t le a s t 1 re cord for this pe rs on a nd this pe rs on is s e le cte d a t
EV10 a nd EV20 a nd code d ‘9’ (OTHER MEDICAL EXPENS ES ), go to OM20.
Othe rwis e , go to OM30.

OM - Page 3 of 13

)

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM20
Item Type:

(OM1030)
Question

Type Class:

Enumerated

Answer Type:

TContinue

Help Available (
Context Header:

)

BLAISE NAME: HCareRec
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

Show Card (

ArrayMax:

Max value:

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:
Health care records were reported for {you/{PERSON}}. Please look at these records while answering the next set of
questions. {Earlier, you mentioned {you/PERSON} } had medical purchases you wanted to talk about. This is the place where
I can record that information. }
PRESS 1 AND ENTER TO CONTINUE.

Responses:

Display
Instructions:

Testing/Editing
Notes:

CONTINUE

OM30

(OM1035)

If a person level variable was previously set at EV25 for the person currently looping on, display
"Earlier you had mentioned {you/{PERSON} } had medical purchases..." Otherwise, use a null display.

Variable collected at MEPSSpring2018.OM_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main

OM - Page 4 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM30
Item Type:

(OM1035)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (OMTpHelp)
Context Header:

BLAISE NAME: Ambulance
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 3

ArrayMax:

Show Card (

Max value:

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:
{Since {START DATE}/Between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} used any ambulance
services?

HELP:F1

Responses:

YES
NO
REFUSED
DON'T KNOW

Programmer
Instructions:

If coded ‘1’, (YES) create OM-record for "AMBULANCE SERVICES".

Display
Instructions:

Testing/Editing
Notes:

1
2
RF
DK

Display ‘Since {START DATE}’ if not round 5. Display ‘Between {START DATE} and {END
DATE}’ if round 5.

Variable collected at MEPSSpring2018.OM_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main

OM - Page 5 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM40
Item Type:

(OM1040)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (
Context Header:

)

BLAISE NAME: DisposSupplies
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

ArrayMax:

Max value:

Show Card (OM-1)

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

Question Text:
 OM-1
Please look at card OM-1, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has}
{you/{PERSON}} purchased any disposable supplies {that we haven’t already talked about as related to
{your/{PERSON}’s} diabetes}?

Responses:

YES
NO
REFUSED
DON'T KNOW

Programmer
Instructions:

If coded ‘1’ (YES), create OM-record for "DISPOSABLE SUPPLIES".

Display
Instructions:

1
2
RF
DK

Display ‘since {START DATE}’ if not round 5. Display ‘between {START DATE} and {END
DATE}’ if round 5.
Display ‘that we haven’t already talked about as related…’ if PM20 or PM40 is coded ‘1’ (YES) for
this person during the current round. Otherwise, use a null display.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.OM_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main

OM - Page 6 of 13

)

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM50
Item Type:

(OM1045)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (
Context Header:

)

BLAISE NAME: MedEquip
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

ArrayMax:

Max value:

Show Card (OM-2)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

Question Text:
 OM-2
Please look at card OM-2, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has}
{you/{PERSON}} purchased any long term medical equipment {that we haven’t already talked about as related to
{your/{PERSON}’s} diabetes}?

Responses:

YES
NO
REFUSED
DON'T KNOW

Programmer
Instructions:

If OM50 coded ‘1’ (YES), create OM-record for "LONG-TERM MEDICAL EQUIPMENT",
go to BOX_40 .

Display
Instructions:

1
2
RF
DK

BOX_40
BOX_40
BOX_40
BOX_40

(OM1050)
(OM1050)
(OM1050)
(OM1050)

Display ‘since {START DATE}’ if not round 5. Display ‘between {START DATE} and
{END DATE}’ if round 5.
Display ‘that we haven’t already talked about as related...’ if PM20 or PM40 is coded ‘1’ (YES) for this
person during the current round. Otherwise, use a null display.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.OM_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main

OM - Page 7 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Rout

Full Detail Spec

BOX_40

Route Details:

(OM1050)

Item Type: Route

Type Class: If Then

If a t le a s t one OM-re cord ha s be e n re porte d for this pe rs on (GLAS S ES /CONTACT
LENS ES re cord cre a te d a t EE40, EE50 or OM10 or OM30=1 ‘AMBULANCE
S ERVICES ’, OM40= 1 ‘DIS POS ABLE S UPPLIES ’, or OM50=1 ‘LONG - TERM
MEDICAL EQUIPMENT’), go to LOOP_10.
Othe rwis e , go to OM80.

LOOP_10

Route Details:

(OM1055)

Item Type: Route

Type Class: Begin Loop

For e a ch OM- re cord re porte d, a s k BOX_50-END_LP10.
Loop de finition: LOOP_10 colle cts informa tion on if gla s s e s /conta cts , a mbula nce
s e rvice s , dis pos a ble s upplie s , or long-te rm me dica l e quipme nt we re obta ine d a t a ll
during pa ne l ye a r 1 or 2, a nd colle cts cha rge pa yme nt informa tion. This loop cycle s on
OM-re cord who me e t the following condition:
-RU me mbe r re porte d a ny OM re cord type a t OM30= ‘1’ (AMBULANCE S ERVICES ),
OM40=‘1’ (DIS POS ABLE S UPPLIES ), OM50=‘3’ (LONG -TERM MEDICAL
EQUIPMENT) OR RU me mbe r ha s a n OM-re cord for “GLAS S ES /CONTACTS ” cre a te d
a t EE40, EE50, or OM10.
Loop by OM-re cord type in the following orde r: GLAS S ES OR CONTACT LENS ES ,
AMBULANCE S ERVICES , DIS POS ABLE S UPPLIES , THEN LONG -TERM MEDICAL
EQUIPMENT.

BOX_50

Route Details:

(OM1060)

Item Type: Route

Type Class: If Then

If round 3 a nd pe rs ons re fe re nce pe riod cros s e s be twe e n pa ne l ye a r 1 a nd pa ne l ye a r
2, continue with OM60. Othe rwis e , go to BOX_60.

OM - Page 8 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM60
Item Type:

(OM1065)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (
Context Header:

)

BLAISE NAME: OMEYear1
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

Show Card (

ArrayMax:

Max value:

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {OME ITEM GROUP}

Question Text:
Did {you/{PERSON}} {obtain/use} {eyeglasses or contact lenses/ambulance services/long-term medical
equipment/disposable supplies} in {PANEL YEAR 1}?

Responses:

Display
Instructions:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

OM70
OM70
OM70
OM70

(OM1070)
(OM1070)
(OM1070)
(OM1070)

If PERSON’s current OM-record being looped on is glasses/contacts, display ‘eyeglasses or contact
lenses’.
If PERSON’s current OM-record being looped on is ambulance services, display ‘ambulance services’.
If PERSON’s current OM-record being looped on is disposable supplies, display ‘disposable supplies’.
If PERSON’s current OM-record being looped on is long-term medical equipment, display ‘long-term
medical equipment’.
If PERSON’s current OM-record being looped on is ambulance services, display ‘use’. Otherwise,
display ‘obtain’.
For ‘PANEL YEAR 1’ display the first calendar year of the panel.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4]
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4]

OM - Page 9 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

OM70
Item Type:

(OM1070)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (
Context Header:

)

BLAISE NAME: OMEYear2
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 1

Show Card (

ArrayMax:

Max value:

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {OME ITEM GROUP}

Question Text:
Did {you/{PERSON}} {obtain/use} {eyeglasses or contact lenses/ambulance services/long-term medical
equipment/disposable supplies} in {PANEL YEAR 2}?

Responses:

Display
Instructions:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

BOX_60
BOX_60
BOX_60
BOX_60

(OM1075)
(OM1075)
(OM1075)
(OM1075)

If PERSON’s current OM-record being looped on is glasses/contacts, display ‘eyeglasses or contact
lenses’.
If PERSON’s current OM-record being looped on is ambulance services, display ‘ambulance services’.
If PERSON’s current OM-record being looped on is disposable supplies, display ‘disposable supplies’.
If PERSON’s current OM-record being looped on is long-term medical equipment, display ‘long-term
medical equipment’.
If PERSON’s current OM-record being looped on is ambulance services, display ‘use’. Otherwise,
display ‘obtain’.
For ‘PANEL YEAR 2’ display the second calendar year of the panel.

Testing/Editing
Notes:

BOX_60

Route Details:

Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4]
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4]

(OM1075)

Item Type: Route

Type Class: If Then

Go to the Cha rge Pa yme nt s e ction for this pe rs on -OM re cord pa ir.
Whe n the Cha rge Pa yme nt s e ction is comple te , go to END_LP10.

OM - Page 10 of 13

MEPS_V2

Other Medical Expenses (OM) Section
(Rout

Full Detail Spec

END_LP10

(OM1080)

Route Details:

Item Type: Route

Type Class: End Loop

If the re a re more OM re cords to loop on for this pe rs on, re turn to LOOP_10.
Othe rwis e , if the re a re no more OM re cords to loop on for this pe rs on, go to OM80.

OM80
Item Type:

(OM1085)
Question

Type Class:

Enumerated

Answer Type:

TOMRecords

Help Available (
Context Header:

)

BLAISE NAME: CodeAllOMRec
Field kind: Datafield
ArrayMin:

Min value:

Field Size:
Answers allowed: 6

Show Card (

ArrayMax:

Max value:

)

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

Question Text:
PLEASE INDICATE ANY {ADDITIONAL} RECORDS USED FOR {PERSON} DURING UTILIZATION,
CHARGE/PAYMENT, PRESCRIBED MEDICINES, AND OTHER MEDICAL EXPENSES.
ENTER ALL THAT APPLY.

Responses:

CALENDAR WITH HEALTH CARE
ENTRIES FOR {PERSON}
PROVIDER/INSURANCE STATEMENT
PATIENT PORTAL
PAYMENT RECORDS
PRESCRIPTION MEDICINE BOTTLES,
TUBES, CONTAINERS, ETC
OTHER TYPE OF RECORD
NO OTHER RECORDS USED
REFUSED
DON'T KNOW

1

BOX_70

(OM1091)

2
3
4
5

BOX_70
BOX_70
BOX_70
BOX_70

(OM1091)
(OM1091)
(OM1091)
(OM1091)

7
8
RF
DK

OM90
BOX_70
BOX_70
BOX_70

(OM1090)
(OM1091)
(OM1091)
(OM1091)

OM - Page 11 of 13

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MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

Programmer
Instructions:

Preloaded grid type 1
Display "ADDITIONAL" if CA30_01= 1, CA30_02=1, CA30_03=1, CA30_04=1, CA30_
05=1, or CA_30_07=1. Otherwise, use a null display.

Display
Instructions:

Col #1 Header: CA30 Responses
Instructions: Display the responses entered at the records grid CA30_01, CA30_02, CA30_03, CA30_
04, CA30_05, and CA30_07. Do not display CA30_06. Display these previously recorded responses as
prefilled values but not editable. Display the number associated with the event type: if CA30_01= 1,
display “1”, if CA30_02=1, display “2”, if CA30_03=1, display “3”, if CA30_04=1, display “4”, if
CA30_05=1, display “5”, if CA_30_07=1, display “7”, if no records coded at CA30_01-CA30_07, use
a null display. Display these numbers with a hyphen separating them for example: 1-3-5.
Col#2 Header: Additional Records
Instructions: Display the responses entered at OM80 (CodeAllOMRec).
Hard checks:
Cannot code OM80 (CodeAllOMRec) as 8 (NO OTHER RECORDS USED) in combination with any
other codes. Display the following error message: “CANNOT CHOOSE "NO OTHER RECORDS
USED" IN COMBINATION WITH OTHER RESPONSES. REVIEW YOUR RESPONSES AND
MAKE ANOTHER SELECTION.”

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.OM_Main.OM_RecordsTable.OM_Records[1..1]
Variable stored at MEPSSpring2018
_PersSect.OM_Main.OM_RecordsTable.OM_Records[1..1]

OM90
Item Type:

(OM1090)
Question

Type Class:

String

Answer Type:

Help Available (
Context Header:

BLAISE NAME: OthOMRec
Field kind: Datafield
ArrayMin:

Field Size: 40
{Continuous Answer.} Answers allowed: 1

)

Show Card (

ArrayMax:

Min value:
Max value:

)

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

Question Text:
ENTER OTHER RECORD.
NOTE: BE AS SPECIFIC AS POSSIBLE.

Responses:

REFUSED
DON'T KNOW

RF
DK
OM - Page 12 of 13

BOX_70

(OM1091)

BOX_70
BOX_70

(OM1091)
(OM1091)

)

MEPS_V2

Other Medical Expenses (OM) Section
(Que

Full Detail Spec

Display
Instructions:

Testing/Editing
Notes:

BOX_70

Route Details:

Variable collected at MEPSSpring2018.OM_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main

(OM1091)

Item Type: Route

Type Class: If Then

Go to next section of the questionnaire.

[End of OM]

OM - Page 13 of 13