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pdf2021 MCBS Facility Instrument
Variable Name
RH- Residence History
MR Screen Name Question Type
Question Text/Description
Code List
Routing
(01) Continue
(01) BOX RH1
Now, I would like to ask you about all the places (SP) has stayed since my last visit, including staying in [other parts (01) Continue
of (LARGER FACILITY)], hospitals or other places.
PRESS "1" TO CONTINUE.
(01) BOX RH1
RESIDENCE HISTORY SECTION SPECIFICATIONS
CRITERIA
SAMPLE TYPE= ALL
SEASON=ALL
PLACEMENT
Administered after FQ section is completed.
BOX RHBEG
routing
RH1PRECT
RH1PRE
code one
RH2PRECT
RH2PRE
code one
BOX RH1
routing
ADMITMM1
RH2
date
ADMITDD1
RH2
date
ADMITYY1
RH2
date
ADMITMM2
RH2A
date
IF SP IS A CFR, GO TO RH2PRE - RH2PRECT.
ELSE GO TO RH1PRE - RH1PRECT.
Now, I would like to ask you about the places where (SP) stayed for one night or more between [January 1,
(CURRENT YEAR)/(his/her) admission to this (facility/home)/(his/her) readmission to this (facility/home)] and today
including staying in [other parts of (LARGER FACILITY),] hospitals or other places.
In answering these questions, it might be helpful for you to review records that show discharges or transfers from
(FACILITY) to [other parts of (LARGER FACILITY),] hospitals or other places.
PRESS "1" TO CONTINUE.
On my last visit on (REF DATE), (SP) was alive and a resident of (FACILITY).
If CFR, GO TO RH7 - RHALIVE.
ELSE IF SP IS EXPECTED IPR1, GO TO RH2 - ADMITMM1.
ELSE GO TO RH2A - ADMITMM2.
On what date was (SP) most recently admitted to (FACILITY)?
MONTH
On what date was (SP) most recently admitted to (FACILITY)?
DAY
On what date was (SP) most recently admitted to (FACILITY)?
YEAR
On what date [on or around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE),] do your records show
(SP) was admitted to (FACILITY)?
IF SP NEVER ADMITTED, ENTER "DK" IN MONTH FIELD.
MONTH
ADMITDD2
RH2A
date
On what date [on or around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE),] do your records show
(SP) was admitted to (FACILITY)?
IF SP NEVER ADMITTED, ENTER "DK" IN MONTH FIELD.
DAY
ADMITYY2
RH2A
date
BOX RH2A1
routing
RH2AVB
verbatim
BOX RH2
routing
On what date [on or around (ADMISSION DATE REPORTED BY A PREVIOUS SOURCE),] do your records show
(SP) was admitted to (FACILITY)?
IF SP NEVER ADMITTED, ENTER "DK" IN MONTH FIELD.
YEAR
WHYADDIS
IF SP IS IPR OR RH2A DATE IS WITHIN +/- 7 DAYS OF ADMISSION DATE REPORTED BY A PREVIOUS
SOURCE, GO TO BOX RH2.
ELSE GO TO RH2AVB - WHYADDIS.
DESCRIBE WHY THERE IS A DISCREPANCY BETWEEN THE ADMISSION DATE REPORTED BY A
PREVIOUS SOURCE AND THE ADMISSION DATE ENTERED DURING THIS INTERVIEW.
IF IPR, GO TO RH6 - RHSEX.
ELSE GO TO RH7 - RHALIVE.
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH2 - ADMITDD1
(-8) RH3 - RH3CT
(-9) RH3 - RH3CT
(01) RH2 - ADMITYY1
(-8) RH3 - RH3CT
(-9) RH3 - RH3CT
(01) BOX RH2
(-8) RH3 - RH3CT
(-9) RH3 - RH3CT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH2 - ADMITDD2
(-8) RH3 - RH3CT
(-9) RH3 - RH3CT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH2 - ADMITYY2
(-8) RH3 - RH3CT
(-9) RH3 - RH3CT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) BOX RH2A1
(-8) RH3 - RH3CT
(-9) RH3 - RH3CT
(01) [Continuous answer.]
(01) BOX RH2
Please tell me the name and title of someone in (FACILITY) who could give me that information.
RECORD RESPONDENT INFORMATION ON PERSON ROSTER AND SELECT ENTRY WHEN RH IS
RESTARTED.
RH3CT
RH3
code one
RHSEX
RH6
code one
ASK IF NOT OBVIOUS.
Is (SP) male or female?
RHALIVE
RH7
yes/no
Is (SP) alive?
BOX RHEND
PRESS "1" TO CONTINUE.
(01) MALE
(02) FEMALE
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(01) RH7 - RHALIVE
(02) RH7 - RHALIVE
(00) RH8 - RHDODMM
(01) BOX RH7
(-8) BOX RH7
(-9) BOX RH7
Page 1 of 5
2021 MCBS Facility Instrument
Variable Name
RH- Residence History
MR Screen Name Question Type
Question Text/Description
On what date did (SP) die?
RHDODMM
RH8
date
RHDODDD
RH8
date
DAY
RHDODYY
RH8
date
YEAR
BOX RH6
routing
BOX RH7
routing
RH9
date
RHDOBMM
MONTH
[IF RESPONDENT ANSWERS "DK", PROBE: Do you know what month (SP) died?]
IF SP IS IPR, GO TO RH3B - RHINEL.
ELSE IF MONTH OR YEAR OF DEATH IS DK OR RF, GO TO RH3 - RH3CT.
ELSE, GO TO BOX RH7.
IF SP IS IPR, GO TO RH9 - RHDOBMM.
ELSE GO TO BOX RH9A.
What (is/was) (SP's) date of birth?
ENTER A 4-DIGIT YEAR.
MONTH
Code List
Routing
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH8 - RHDODDD
(-8) BOX RH6
(-9) BOX RH6
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH8 - RHDODYY
(-8) RH8 - RHDODYY
(-9) RH8 - RHDODYY
(01) BOX RH6
(-8) BOX RH6
(-9) BOX RH6
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH9 - RHDOBDD
(-8) RH9 - RHDOBDD
(-9) RH9 - RHDOBDD
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH9 - RHDOBYY
(-8) RH9 - RHDOBYY
(-9) RH9 - RHDOBYY
(01) BOX RH9A
(-8) BOX RH9A
(-9) BOX RH9A
(01) BOX RH9A
(-8) BOX RH9A
(-9) BOX RH9A
RHDOBDD
RH9
date
DAY
RHDOBYY
RH9
date
YEAR
RHAGE
RH10
numeric
Approximately how old is (SP)?
BOX RH9A
routing
IF SP IS A CFR, GO TO RH11A - RHPROBE1.
ELSE GO TO RH11B - RHPROBE2.
RHPROBE1
RH11A
yes/no
Between (REF DATE), (the date of my last visit), and (RH END OF REFERENCE PERIOD) has (SP) been in
(FACILITY) the whole time or has (he/she) spent one or more nights [in another part of (LARGER FACILITY),] in a
hospital, or in some other place?
(00) NO, THEY WERE ALSO IN SOME OTHER PLACE
(01) YES, THEY RESIDED IN THIS FACILITY THE
WHOLE TIME
(-9) Refused
(00) BOX RH13A
(01) BOX RH10
(-9) BOX RH10
RHPROBE2
RH11B
yes/no
Between (REF DATE) and (RH END OF REFERENCE PERIOD) has (SP) been in (FACILITY) the whole time or
has (she/he) spent one or more nights [in another part of (LARGER FACILITY),] in a hospital, or in some other
place?
(00) NO, THEY WERE ALSO IN SOME OTHER PLACE
(01) YES, THEY RESIDED IN THIS FACILITY THE
WHOLE TIME
(-9) Refused
(00) BOX RH13A
(01) BOX RH10
(-9) BOX RH10
RHPROBE3
RH12
yes/no
Between (CURRENT START DATE) and (END OF RH REFERENCE PERIOD) was (SP) in (CURRENT PLACE)
the whole time?
(00) NO, THEY LEFT THIS PLACE
(01) YES, THEY RESIDED HERE THE WHOLE TIME
(-8) Don't Know
(-9) Refused
(00) BOX RH13A
(01) BOX RH10
(-8) BOX RH10
(-9) BOX RH10
BOX RH10
routing
(IF RH11A-RHPROBE1 = 1/YesTheyResidedHereTheWholeTime, OR
RH11B-RHPROBE2 = 1/YesTheyResidedHereTheWholeTime, OR
RH12-RHPROBE3 = 1/YesTheyResidedHereTheWholeTime) AND SP IS ALIVE OR VITAL STATUS IS NOT
KNOWN, GO TO BOX RH24.
(IF RH11A-RHPROBE1 = RF, OR
RH11B-RHPROBE2 = RF, OR
RH12-RHPROBE3 = DK or RF) AND SP IS ALIVE OR VITAL STATUS IS NOT KNOWN, GO TO RH12B CURSTIL.
ELSE GO TO RH12A - CURDIED.
CURDIED
RH12A
code one
Was (he/she) in (CURRENT PLACE) when (he/she) died on (DATE OF DEATH) or somewhere else?
(00) SOMEWHERE ELSE
(01) IN (FACILITY)
(-8) Don't Know
(-9) Refused
(00) BOX RH13A
(01) BOX RH24
(-8) BOX RH24
(-9) BOX RH24
CURSTIL
RH12B
yes/no
Is (he/she) still at (CURRENT PLACE)?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX RH13A
(01) BOX RH24
(-8) BOX RH24
(-9) BOX RH24
BOX RH13A
routing
STAYEMM
RH13
date
GO TO RH13 - STAYEMM.
When did (SP) leave (CURRENT PLACE)?
STAYEDD
RH13
date
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH13 - STAYEDD
(-8) RH13 - STAYEDD
(-9) RH13 - STAYEDD
(01) RH13 - STAYEYY
(-8) RH13 - STAYEYY
(-9) RH13 - STAYEYY
MONTH
When did (SP) leave (CURRENT PLACE)?
DAY
Page 2 of 5
2021 MCBS Facility Instrument
Variable Name
STAYEYY
RH- Residence History
MR Screen Name Question Type
RH13
date
BOX RH11
routing
STAYNITE
RH14
numeric
XSTPLACS
RH21
roster
XSTPLACN
LOCTEMP
BOX RH12
routing
RH21A
Text
BOX RH13
routing
RH21B
yes/no
Question Text/Description
Code List
Routing
When did (SP) leave (CURRENT PLACE)?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) BOX RH11
(-8) BOX RH11
(-9) BOX RH11
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH21 - XSTPLACS
(-8) RH21 - XSTPLACS
(-9) RH21 - XSTPLACS
(01) [Continuous answer.]
(01) BOX RH12
(01) [Continuous answer.]
(01) BOX RH13
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) RH22 - PLACKIRH
(01) RH22 - PLACKIRH
(-8) RH22 - PLACKIRH
(-9) RH22 - PLACKIRH
(01) NURSING HOME/REHAB CENTER
(02) PERSONAL CARE HOME/RESIDENTIAL CARE
FACILITY
(03) CCRC/RETIREMENT HOME/CENTER
(04) HOSPITAL
(05) PRIVATE HOME OR APARTMENT
(07) OTHER LTC FACILITY
(91) OTHER
(01) BOX RH15
(02) BOX RH15
(03) BOX RH15
(04) BOX RH15
(05) BOX RH15
(07) BOX RH15
(91) RH22 - PLKIRHOS
YEAR
IF ANY PART OF RH13 DATE IS MISSING, GO TO RH14 - STAYNITE.
ELSE GO TO RH21 - XSTPLACS.
About how many nights did (he/she) spend there?
[Where did (he/she) go on (START DATE)?/Where is (he/she) living now?/Where was (he/she) staying when
(he/she) died on (DATE OF DEATH)?]
SELECT NAME FROM LIST OR SELECT "[NEED TO ADD PLACE]".
IF RH21-XSTPLACS = "[NEED TO ADD PLACE]", GO TO RH21A - XSTPLACN.
ELSE GO TO BOX RH13.
ENTER THE NAME OF THE PLACE.
IF PLACE ADDED AT RH21A-XSTPLACN AND FACILITY IS PART OF A LARGER PLACE, GO TO RH21B LOCTEMP.
ELSE IF PLACE ADDED AT RH21A-XSTPLACN, GO TO RH22 - PLACKIRH.
ELSE IF PLACE SELECTED IS A HOSPITAL, GO TO RH25 - SNFWING.
ELSE GO TO BOX RH18.
Is (ADDED PLACE NAME) part of (LARGER FACILITY NAME)?
SHOW CARD RH1
Please look at this card and tell me what kind of place (ADDED PLACE NAME) is:
PLACKIRH
RH22
code one
PRESS F1 FOR DEFINITIONS.
USE SCROLLBAR ON RIGHT SIDE OF THE SCREEN TO SCROLL DOWN AND VIEW THE BENEFICIARY’S
STAY REPORT.
PLKIRHOS
SNFWING
RH22
verbatim
OTHER (SPECIFY)
BOX RH15
routing
IF RH22 - PLACKIRH = 1/NursingHomeRehabCenter, 2/PersonalCareHome, OR 7/OtherLtcFacility, GO TO BOX
RH24.
ELSE IF RH22 - PLACKIRH = 3/CcrcRetirementHomeCenter, GO TO BOX RH18.
ELSE IF RH22 - PLACKIRH = 4/Hospital, GO TO RH25 - SNFWING.
ELSE GO TO RH30A - LALONE.
RH25
yes/no
Was (SP) staying in a SNF wing or SNF unit of (CURRENT PLACE)?
(01) [Continuous answer.]
(01) BOX RH15
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX RH24
(01) BOX RH24
(-8) BOX RH24
(-9) BOX RH24
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX RH19
(01) BOX RH19
(-8) BOX RH19
(-9) BOX RH19
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH28 - NWINGCIT
(-8) RH28 - NWINGCIT
(-9) RH28 - NWINGCIT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH28 - NWINGSTA
(-8) RH28 - NWINGSTA
(-9) RH28 - NWINGSTA
(01) BOX RH21
(-8) BOX RH21
(-9) BOX RH21
IF PLACKIND OF PLACE ADDED OR SELECTED = 1/NursingHomeRehabCenter,
2/PersonalCareHomeResidentialCareFacility, OR 7/OtherLtcFacility AND RH12-RHPROBE3 = 1/Yes AND SP IS
ALIVE OR VITAL STATUS IS NOT KNOWN, GO TO BOX RH31.
NURWING
NAMNWING
BOX RH18
routing
RH27
Yes/No
BOX RH19
routing
RH28
Text
ELSE IF PLACKIND OF PLACE ADDED OR SELECTED = 1/NursingHomeRehabCenter,
2/PersonalCareHomeResidentialCareFacility, OR 7/OtherLtcFacility AND (RH11A-RHPROBE1 = 0/No, DK, or RF,
OR RH11B-RHPROBE2 = 0/No, DK, or RF, OR RH12-RHPROBE3 = 0/No, DK, or RF) OR SP IS DECEASED
AND PLACE SELECTED IS TARGET FACILITY, GO TO BOX RH24.
IF PLACKIND = 5/PrivateHomeOrApartment OR 91/Other, GO TO RH30A - LALONE .
ELSE IF PLACKIND = 3/CcrcRetirementHomeCenter, GO TO RH27 - NURWING.
Was (he/she) staying in a nursing wing, nursing unit, assisted living unit, or personal care unit of (CURRENT
PLACE)?
IF RH27-NURWING = 1/Yes, GO TO RH28 - NAMNWING.
ELSE GO TO RH29 - PRIVHOME.
[INTERVIEWER: ASK THE FOLLOWING QUESTIONS AND RECORD THE INFORMATION, AS AVAILABLE.
SELECT "DON'T KNOW" FOR ANY ITEM THAT IS NOT AVAILABLE.]
What is the name of this nursing wing, nursing unit, assisted living unit or personal care unit?
NWINGCIT
RH28
Text
In what city is this place located?
NWINGSTA
RH28
Text
In what state is this place located?
Page 3 of 5
2021 MCBS Facility Instrument
Variable Name
PRIVHOME
LALONE
RH- Residence History
MR Screen Name Question Type
Question Text/Description
Code List
Routing
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX RH21
(01) BOX RH21
(-8) BOX RH21
(-9) BOX RH21
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) RH30 - LWITH
(01) BOX RH24
(-8) BOX RH24
(-9) BOX RH24
(01) SPOUSE
(02) DAUGHTER
(03) SON
(04) MOTHER
(05) FATHER
(06) SISTER
(07) BROTHER
(08) GUARDIAN
(09) OTHER FEMALE RELATIVE
(10) OTHER MALE RELATIVE
(11) OTHER NONRELATIVE
(-8) Don't Know
(-9) Refused
(01) BOX RH24
(02) BOX RH24
(03) BOX RH24
(04) BOX RH24
(05) BOX RH24
(06) BOX RH24
(07) BOX RH24
(08) BOX RH24
(09) BOX RH24
(10) BOX RH24
(11) BOX RH24
(-8) BOX RH24
(-9) BOX RH24
RH29
yes/no
Was (he/she) staying in a private home or apartment at (CURRENT PLACE)?
BOX RH21
routing
IF RH29-PRIVHOME = 1/Yes, GO TO RH30A - LALONE.
ELSE GO TO BOX RH24.
RH30A
yes/no
(Did/Does) (SP) live there alone?
Who (lived/lives) with (him/her) there?
LWITH
RH30
code all
BOX RH24
routing
BOX RH31
routing
BOX RH36
routing
SELECT ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF ALL DAYS IN REFERENCE PERIOD ACCOUNTED FOR AND SP'S LAST STAY IS IN A PLACE OTHER
THAN THE TARGET FACILITY, GO TO BOX RH36.
IF ALL DAYS IN REFERENCE PERIOD ACCOUNTED FOR AND SP IS STILL A RESIDENT OF THE TARGET
FACILITY, GO TO RH49A - CNSNTREQ.
ELSE GO TO RH12 - RHPROBE3.
IF (SP IS ALIVE OR SP'S VITAL STATUS IS NOT KNOWN ) AND NOT A RESIDENT OF TARGET FACILITY, GO
TO BOX RH36.
ELSE GO TO RH49A - CNSNTREQ.
GO TO RH36 - FORMDIS.
Earlier you told me (SP) had been discharged to (DISCHARGE PLACE).
Was (SP) formally discharged from (FACILITY) for the stay at (LAST PLACE NAME FROM RH21) that began on
(DISCHARGE DATE)?
FORMDIS
RH36
yes/no
(00) NO
IF YOU ARE AT THIS SCREEN THEN THE BENEFICIARY HAS BEEN RECORDED AS BEING DISCHARGED
(01) YES
FROM THE FACILITY, EITHER FORMALLY OR INFORMALLY, AND THIS CASE WILL CROSSOVER WHEN
(-8) Don't Know
THE INTERVIEW IS COMPLETE. IF THE BENEFICIARY HAS NOT BEEN DISCHARGED FROM THE FACILITY, (-9) Refused
PLEASE PRESS THE "UP" ARROW ON YOUR KEYBOARD TO GO BACK TO THE PREVIOUS SCREEN (RH12)
AND MAKE SURE IT IS ANSWERED CORRECTLY.
(00) RH49A - CNSNTREQ
(01) RH48 - CONTNAME
(-8) RH49A - CNSNTREQ
(-9) RH49A - CNSNTREQ
PRESS F1 FOR DEFINITION OF FORMAL DISCHARGE.
CONTNAME
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
NAME
CONTADDR
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
ADDRESS
CONTCITY
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
CITY
CONTSTAT
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
STATE
CONTZIP
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
ZIP CODE
CONTAREA
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
AREACODE
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTADDR
(-8) RH48 - CONTADDR
(-9) RH48 - CONTADDR
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTCITY
(-8) RH48 - CONTCITY
(-9) RH48 - CONTCITY
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTSTAT
(-8) RH48 - CONTSTAT
(-9) RH48 - CONTSTAT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTZIP
(-8) RH48 - CONTZIP
(-9) RH48 - CONTZIP
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTAREA
(-8) RH48 - CONTAREA
(-9) RH48 - CONTAREA
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTEXCH
(-8) RH48 - CONTEXCH
(-9) RH48 - CONTEXCH
Page 4 of 5
2021 MCBS Facility Instrument
Variable Name
CONTEXCH
RH- Residence History
MR Screen Name Question Type
RH48
text
Question Text/Description
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
EXCHANGE
CONTLOCL
RH48
text
Please tell me the name, address, and telephone number of someone we could contact regarding (SP) at
(DISCHARGE PLACE).
LOCAL
CONTREL
RH49
code one
What is the relationship of (CONTACT NAME FROM RH48) to (SP)?
CONTRFOS
CONTRMOS
CONTNROS
RH49
RH49
RH49
Text
Text
Text
CNSNTREQ
RH49A
yes/no
OTHER FEMALE RELATIVE (SPECIFY)
OTHER MALE RELATIVE (SPECIFY)
OTHER NON-RELATIVE (SPECIFY)
WAS "CONSENT" REQUIRED AND OBTAINED FOR THIS SP?
PRESS F1 FOR A DEFINITION OF "CONSENT".
WRITVERB
RH49B
yes/no
DIDABRH
RH50
code one
WAS THE "CONSENT" WRITTEN OR VERBAL (BY TELEPHONE)?
Code List
Routing
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTLOCL
(-8) RH48 - CONTLOCL
(-9) RH48 - CONTLOCL
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) RH48 - CONTREL
(-8) RH48 - CONTREL
(-9) RH48 - CONTREL
(01) SP
(02) SPOUSE
(03) DAUGHTER
(04) SON
(05) MOTHER
(06) FATHER
(07) SISTER
(08) BROTHER
(09) DAUGHTER-IN-LAW
(10) SON-IN-LAW
(11) GRANDDAUGHTER
(12) GRANDSON
(13) NIECE
(14) NEPHEW
(15) FRIEND/NEIGHBOR
(16) NURSE/NURSE'S AIDE
(17) BOARDER
(18) GUARDIAN
(91) OTHER FEMALE RELATIVE
(92) OTHER MALE RELATIVE
(93) OTHER NONRELATIVE
(-8) Don't Know
(-9) Refused
(01) RH49A - CNSNTREQ
(02) RH49A - CNSNTREQ
(03) RH49A - CNSNTREQ
(04) RH49A - CNSNTREQ
(05) RH49A - CNSNTREQ
(06) RH49A - CNSNTREQ
(07) RH49A - CNSNTREQ
(08) RH49A - CNSNTREQ
(09) RH49A - CNSNTREQ
(10) RH49A - CNSNTREQ
(11) RH49A - CNSNTREQ
(12) RH49A - CNSNTREQ
(13) RH49A - CNSNTREQ
(14) RH49A - CNSNTREQ
(15) RH49A - CNSNTREQ
(16) RH49A - CNSNTREQ
(17) RH49A - CNSNTREQ
(18) RH49A - CNSNTREQ
(91) RH49 - CONTRFOS
(92) RH49 - CONTRMOS
(93) RH49 - CONTNROS
(-8) RH49A - CNSNTREQ
(-9) RH49A - CNSNTREQ
(01) [Continuous answer.]
(01) [Continuous answer.]
(01) [Continuous answer.]
(00) NO
(01) YES
(01) WRITTEN
(02) VERBAL
(01) RH49A - CNSNTREQ
(01) RH49A - CNSNTREQ
(01) RH49A - CNSNTREQ
(00) RH50 - DIDABRH
(01) RH49B - WRITVERB
(01) RH50 - DIDABRH
(02) RH50 - DIDABRH
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
(04) SOME
THE AMOUNT YOU ABSTRACTED. IF THERE WAS NO ABSTRACTION AT ALL, PLEASE SELECT "NONE".
(05) NONE
(01) RH51 - WHYABRH
(02) RH51 - WHYABRH
(03) RH51 - WHYABRH
(04) RH51 - WHYABRH
(05) RHEND - RHENDCNT
DID YOU ABSTRACT?
WHYABRH
RH51
code one
WHY DID YOU ABSTRACT?
WHYABROS
RH51
verbatim
RHINEL
RH3B
code one
OTHER (SPECIFY)
Thank you. Those are all the questions I have for you at the moment. Someone from my office may call you to
verify some of the data I have collected. We appreciate your help on this important study.
PRESS "1" TO CONTINUE.
THANK THE RESPONDENT.
PRESS "1" TO RETURN TO THE NAVIGATION SCREEN.
GO TO NAVIGATOR
RHENDCNT
RHEND
code one
BOX RHEND
routing
(01) NO KNOWLEDGEABLE RESPONDENT
AVAILABLE
(02) NO TIME/STAFF BURDEN TOO GREAT
(03) REFUSAL--UNWILLING TO COOPERATE
(91) OTHER
(01) RHEND - RHENDCNT
(02) RHEND - RHENDCNT
(03) RHEND - RHENDCNT
(91) RH51 - WHYABROS
(01) [Continuous answer.]
(01) RHEND - RHENDCNT
(01) Continue
(01) BOX RHEND
(01) Continue
(01) BOX RHEND
Page 5 of 5
File Type | application/pdf |
Author | Samantha Rosner |
File Modified | 2020-11-10 |
File Created | 2020-11-10 |