CMS-P-0015A Preventive Care

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PVQ-PREVENTIVE CARE

Question Text/Description

Code List

Routing

PREVENTIVE CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in (C001, C002, C003, C004, C005, C006) and SEASON=FALL, administer after MBQ.
If INTTYPE in (C001, C004, C005) and SEASON=WINTER or SUMMER, administer after CPS
If INTTYPE in (C002, C006, C007, C010) and SEASON=SUMMER or WINTER, administer after NSQ

PVINTRO

FLUSHOT

BOX PVBEG

routing

PVINT

No entry

PVF1

yes/no

BOX PV1

routing

IF RESPONDENT IS DECEASED, GO TO BOX PVEND.
ELSE IF SEASON=FALL, GO TO PV8 - PREVHLTHINTRO.
ELSE IF (SEASON=WINTER), GO TO PVINT-PVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1-FLUSHOT^=1/YES), GO TO PVINTPVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1-FLUSHOT=1/YES), GO TO BOX
PV4.
IF SEASON=WINTER, FILL "Now I’d like to ask you some questions about the seasonal flu vaccine."
ELSE IF SEASON=SUMMER, FILL "At the time of the last interview, we recorded that [you/(SP)] had not gotten a flu
vaccination for the [CURRENT YEAR MINUS 1] - [CURRENT YEAR] flu season."
Since [July 1st, (CURRENT YEAR MINUS 1)/[MREFDATE]], [have you/has (SP)] had a seasonal flu vaccination?
IF THE RESPONDENT MENTIONS A SHORT NEEDLE OR NEEDLELESS INJECTOR, CODE AS “YES”.

PVF2

code all

FLUOTHOS

PVF2

verbatim text

BOX PV2

routing

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

OTHER (SPECIFY)
IF MORE THAN ONE RESPONSE SELECTED AS YES AT PVF2-FLUCODE, GO TO PVF3-PVFLU3, ELSE GO TO
BOX PV3
Of the reasons you listed, what is the main reason [you/(SP)] did not get a flu vaccination this flu season?

PVFLU3

PVF3

code one

BOX PV3

routing

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

(01) FLUSITE-FLUSITE
(02) BOX PV1
(-8) BOX PV4
(-9) BOX PV4

(01) I WAS SICK WITH FLU SO I DON’T’ NEED THE
VACCINE
(02) I DIDN’T KNOW THE VACCINE WAS NEEDED
(03) THE VACCINE COULD GIVE ME FLU
(04) THE VACCINE COULD HAVE SIDE EFFECTS OR
IS NOT SAFE
(05) I DON’T THINK THE VACCINE WILL PREVENT
THE FLU
(06) FLU IS NOT SERIOUS
(07) MY DOCTOR DID NOT TELL ME THAT I SHOULD
GET THE VACCINE
(08) MY DOCTOR TOLD ME NOT TO GET THE
VACCINE
(09) I DON'T LIKE VACCINES OR NEEDLES
(10) I COULDN’T GET TO THE PLACE WHERE THEY
WERE OFFERING THE VACCINE
(11) I COULDN’T FIND A PLACE THAT WAS OFFERING
THE VACCINE
(12) I FORGOT
(13) I COULDN’T AFFORT THE VACCINE
(14) I HAD VACCINE BEFORE AND DON’T NEED TO
GET IT AGAIN
(15) THE VACCINE WAS NOT AVAILABLE
(16) THE VACCINE IS NOT WORTH THE MONEY
(17) I DIDN'T HAVE TIME TO GET THE VACCINE
(18) I’M NOT IN A HIGH RISK/PRIORITY GROUP
(19) I HAVE AN ONGOING HEALTH
CONDITION/ALLERGE/MEDICAL REASON THAT
PREVENT ME FROM GETTING THE VACCINE
(20) I DON'T TRUST WHAT GOVERNMENT SAYS
ABOUT VACCINE
(91) OTHER

(01) BOX PV2
(02) BOX PV2
(03) BOX PV2
(04) BOX PV2
(05) BOX PV2
(06) BOX PV2
(07) BOX PV2
(08) BOX PV2
(09) BOX PV2
(10) BOX PV2
(11) BOX PV2
(12) BOX PV2
(13) BOX PV2
(14) BOX PV2
(15) BOX PV2
(16) BOX PV2
(17) BOX PV2
(18) BOX PV2
(19) BOX PV2
(20) BOX PV2
(91) PVF2 - FLUOTHOS
(-8) BOX PV2
(-9) BOX PV2

[LIST ALL RESPONSES SELECTED AT PVF2FLUCODE]
_ _ [ENTER MAIN REASON]
(-8) DON’T KNOW
(-9) REFUSED

BOX PV3

IF SEASON=WINTER OR (IF SEASON=SUMMER AND P_FLUSHOT in (., -7, -8), GO TO PVF2-FLUCODE.
ELSE GO TO BOX PV4.

For what reason didn't [you/(SP)] get a seasonal flu vaccination since July 1st?
FLUCODE

PVF1-FLUSHOT

READ LIST TO RESPONDENT. IF RESPONDENT SELECTS MORE THAN ONE REASON PROBE FOR MAIN
REASON.
IF RESPONSE TO PVF2-FLUCODE DOES NOT INCLUDE 15, GO TO PVF5-VACAVAIL..
ELSE GO TO BOX PV4.

BOX PV2

Page 1 of 5

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

FLUSITE

FLUSITE

code one

FLUSITOS

FLUSITOS

verbatim text

VACPAID

VACPAID

yes/no

VACAVAIL

SHINGVAC

PNEUSHOT

PVF5

yes/no

BOX PV4

routing

PV6

yes/no

BOX PV5

routing

PV7

PREVHLTHINTRO PV8

WELLNESS

PV8A

PVQ-PREVENTIVE CARE

Question Text/Description

Where did [you/(SP)] go for [your/his/her] most recent seasonal flu shot, was that a managed care plan or HMO
center, a clinic, a doctor’s office, a hospital, a health fair, shopping mall, or some other place?
[IF CLINIC, ASK: Was it a hospital outpatient clinic, or some other kind of clinic? IF SOME OTHER PLACE, ASK:
Where was this?]

OTHER (SPECIFY)
Did [you/(SP)] pay some or all of the cost of the flu shot?
Please include any monetary donations that [you/(SP)] may have made to cover the cost of the flu shot.

PV9

Routing

(01) DOCTORS OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY HEALTH CENTER
(05) RURAL HEALTH CLINIC
(06) COMPANY CLINIC/WORKPLACE
(07) OTHER CLINIC
(08) WALK-IN URGENT CENTER
(09) HOSPITAL EMERGENCY ROOM
(10) HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
(11) VA FACILITY
(12) HEALTH FAIR
(13) SHOPPING MALL/OTHER STORE
(14) SENIOR CENTER
(15) AT HOME
(16) CHURCH/SCHOOL
(17) LIBRARY
(18) HOSPITAL INPATIENT
(19) PHARMACY/DRUG STORE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(01) VACPAID - VACPAID
(02) VACPAID - VACPAID
(03) VACPAID - VACPAID
(04) VACPAID - VACPAID
(05) VACPAID - VACPAID
(06) VACPAID - VACPAID
(07) VACPAID - VACPAID
(08) VACPAID - VACPAID
(09) VACPAID - VACPAID
(10) VACPAID - VACPAID
(11) VACPAID - VACPAID
(12) VACPAID - VACPAID
(13) VACPAID - VACPAID
(14) VACPAID - VACPAID
(15) VACPAID - VACPAID
(16) VACPAID - VACPAID
(17) VACPAID - VACPAID
(18) VACPAID - VACPAID
(19) VACPAID - VACPAID
(91) FLUSITOS - FLUSITOS
(-8) VACPAID - VACPAID
(-9) VACPAID - VACPAID

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

Did [you/(SP)] have any trouble getting a seasonal flu shot when (you/he/she) wanted to because the vaccine was in
(01) YES
short supply or unavailable?
(02) NO
(-8) DON'T KNOW
[IF NEEDED: This question is asking about whether the seasonal flu shot was available to [you/ (SP)], regardless if
(-9) REFUSED
[you/ (SP)] did not receive or want one.]
IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE SHINGLES
VACCINE (P_SHINGVAC^=1) AND RESPONDENT IS AGE 60 OR ABOVE (AGECALC ≥ 60) OR RESPONDENT
IS AGE=0, GO TO PV6-SHINGVAC.
ELSE GO TO BOX PV5.
Shingles is an illness that results in a rash or blisters on the skin, and is usually painful. There are two vaccines now (01) YES
available for shingles; Zostavax®, which requires 1 shot, and Shingrix®, a new vaccine which requires 2 shots.
(02) NO
(-8) DON'T KNOW
[Have you/Has (SP)] had a vaccine for Shingles?
(-9) REFUSED
IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE PNEUMONIA
VACCINE (PNEUSHOT^=1), GO TO PV7-PNEUSHOT.
ELSE GO TO BOX PVEND.
[Have you/Has (SP)] EVER had a pneumonia shot?

BOX PV4

BOX PV5

(01) CONTINUE
(-7) EMPTY

PV8A- WELLNESS

no entry

These next few questions are about preventive health care measures some people take.

yes/no

Within the first 12 months of a beneficiary’s Medicare enrollment, Medicare pays for a one-time “Welcome to
Medicare” visit with their primary care provider to assess their current health. After a beneficiary has been enrolled in
(01) YES
Medicare for 12 months, Medicare pays for “Annual Wellness” visits. These visits are yearly appointments with the
(02) NO
beneficiary’s primary care provider to update their personalized prevention plan.
(-8) DON'T KNOW
(-9) REFUSED
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has SP] had either a “Welcome to Medicare” or an “Annual
Wellness” visit?

When was the most recent time [you/(SP)] had [your/his/her] blood pressure taken by a doctor or other health
professional?

PVF5-VACAVAIL

BOX PVEND

This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called
the pneumococcal vaccine. There are two types of pneumonia shots: polysaccharide, also known as
Pneumovax®23, and conjugate, also known as Prevnar13®.

code one

VACPAID - VACPAID

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

yes/no

SHOW CARD PV1
BPTAKEN

Code List

(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD BLOOD PRESSURE TAKEN
(-8) DON'T KNOW
(-9) REFUSED

PV9-BPTAKEN

PV10 - BCTAKEN

Page 2 of 5

2023 MCBS Community Questionnaire

Variable Name

BCTAKEN

MR Screen Name Question Type

PV10

code one

BOX PV5A

routing

BASKORAL

PV10A

yes/no

CASKORAL

PV10B

yes/no

OCCEXAM

PV10C

code one

BOX PV5C

routing

BTSTHIV

RCNTHIV

CTSTHIV

PV19

PV21

yes/no

code one

PVQ-PREVENTIVE CARE

Question Text/Description

SHOW CARD PV2
When was the most recent time [you/(SP)] had [your/his/her] cholesterol checked?

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO PV10A-BASKORAL.
ELSE GO TO PV10B-CASKORAL.

Routing

(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD CHOLESTEROL CHECKED
(-8) DON'T KNOW
(-9) REFUSED

BOXPV5A

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has SP] had an exam for oral cancer in which the doctor or
(02) NO
dentist pulls on [your/his/her] tongue, sometimes with gauze wrapped around it, and feels under the tongue and
(-8) DON'T KNOW
inside the cheeks?
(-9) REFUSED
(01) WITHIN THE PAST YEAR
When did [you/SP] have [your/his/her] most recent oral or mouth cancer exam?
(02) BETWEEN 1 AND 3 YEARS AGO
(03) OVER 3 YEARS AGO
Was it within the past year, between 1 and 3 years ago, or over 3 years ago?
(-8) DON'T KNOW
(-9) REFUSED
ELSE IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO PV19-BTSTHIV.
ELSE GO TO PV20-CTSTHIV.
(01) YES
The next question is about the test for HIV, the virus that causes AIDS. Except for tests [you/(SP)] may have had as (02) NO
part of blood donations, [have you/ has he/ has she] ever been tested for HIV?
(-8) DON'T KNOW
(-9) REFUSED
[Have you/Has SP] ever had an exam for oral cancer in which the doctor or dentist pulls on [your/his/her] tongue,
sometimes with gauze wrapped around it, and feels under the tongue and inside the cheeks?

When did [you/(SP)] have [your/his/her] most recent HIV test?

(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(-8) DON'T KNOW
(-9) REFUSED

(01) YES
The next question is about the test for HIV, the virus that causes AIDS. Except for tests [you/(SP)] may have had as
(02) NO
part of blood donations, since (SAMPLE_PERSON.DATE_FALLRND) [ have you/ has he/ has she] been tested for
(-8) DON'T KNOW
HIV?
(-9) REFUSED
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO PV22-WHYNHIV
ELSE GO TO BOX PV6

PV20
BOX PV5D

SHOW CARD PV3
WHYNHIV

Code List

PV22

code one

BOX PV6

routing

I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes
AIDS). Which one of these would you say is the MAIN reason why [you have/(SP) has] not been tested?

(01) IT’S UNLIKELY YOU’VE BEEN EXPOSED TO HIV
(02) YOU WERE AFRAID TO FIND OUT IF YOU WERE
HIV POSITIVE (THAT YOU HAD HIV)
(03) DR. DID NOT PRESCRIBE OR RECOMMEND IT
(04) YOU DIDN’T WANT TO THINK ABOUT HIV OR
ABOUT BEING HIV POSITIVE
(05) YOU WERE WORRIED YOUR NAME WOULD BE
REPORTED TO THE GOVERNMENT IF YOU TESTED
POSITIVE
(06) YOU DIDN’T KNOW WHERE TO GET TESTED
(07) YOU DON’T LIKE NEEDLES
(08) YOU WERE AFRAID OF LOSING JOB,
INSURANCE, HOUSING, FRIENDS, FAMILY, IF
PEOPLE KNEW YOU WERE POSITIVE FOR AIDS
INFECTION
(09) SOME OTHER REASON
(10) NO PARTICULAR REASON
(-8) REFUSED
(-9) DON’T KNOW

(01) PV10C-OCCEXAM
(02) BOX PV5C
(-8) BOX PV5C
(-9) BOX PV5C
BOX PV5C

BOX PV5C

(01) PV21-RCNTHIV
(02) BOX PV5D
(-8) BOX PV6
(-9) BOX PV6

BOX PV6

(01) BOX PV6
(02) BOX PV5D
(-8) BOX PV6
(-9) BOX PV6

BOX PV6

IF SP IS FEMALE, GO TO PV11 - MAMMOGRM.
ELSE GO TO BOX PV8.

Page 3 of 5

2023 MCBS Community Questionnaire

Variable Name
MAMMOGRM

MR Screen Name Question Type
PV11

PVQ-PREVENTIVE CARE

Question Text/Description

Code List

Routing

yes/no

[Have you/Has (SP)] had a mammogram or a breast X-ray since (SAMPLE_PERSON.DATE_FALLRND)?

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

(01) PV12 - PAPSMEAR
(02) PV11 - MAMCODE
(-8) PV12 - PAPSMEAR
(-9) PV12 - PAPSMEAR

MAMCODE

PV11

code all

(01) DIDN’T KNOW IT WAS NEEDED/NO
NEED/NOTHING WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A
DIFFERENT SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT BREAST
CANCER/COULD GET BREAST CANCER
ANYWAY/TEST IS USELESS
(04) NOT AT RISK FOR BREAST CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND
IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE MAMMOGRAMS/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
What is the reason that [you have/(SP) has] not had a mammogram since (SAMPLE_PERSON.DATE_FALLRND)?
LOCATION/TRANSPORTATION DIFFICULTY
CHECK ALL THAT APPLY.
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF MAMMOGRAM/INSURANCE DOESN’T
COVER COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) MAMMOGRAM RADIATION COULD CAUSE
CANCER/ILL EFFECTS
(13) NEVER HEARD OF MAMMOGRAM
(14) APPOINTMENT SCHEDULED FOR FUTURE DATE
(15) MASTECTOMY/BREASTS REMOVED
(16) TOO ILL, PHYSICALLY/MENTALLY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

MAMNOTHS

PV11

verbatim text

OTHER (SPECIFY)

PAPSMEAR

PV12

yes/no

[Have you/Has (SP)] had a Pap smear test since (SAMPLE_PERSON.DATE_FALLRND)?

PAPCODE

PV13

code all

What is the reason that [you have/(SP) has] not had a Pap smear test since
(SAMPLE_PERSON.DATE_FALLRND)?
CHECK ALL THAT APPLY.

PAPNOTHS

PV13

verbatim text

OTHER (SPECIFY)

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) DIDN’T KNOW IT WAS NEEDED/NO
NEED/NOTHING WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A
DIFFERENT SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT
CANCER/COULD GET CANCER ANYWAY/TEST IS
USELESS
(04) NOT AT RISK FOR CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND
IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE PAP SMEAR/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
LOCATION/TRANSPORTATION DIFFICULTY
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF PAP SMEAR/INSURANCE DOESN’T
COVER COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) NEVER HEARD OF PAP SMEAR
(13) APPOINTMENT SCHEDULED FOR FUTURE DATE
(14) HAD HYSTERECTOMY/NO UTERUS, OVARIES
(15) TOO ILL, PHYSICALLY/MENTALLY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(01) PV12 - PAPSMEAR
(02) PV12 - PAPSMEAR
(03) PV12 - PAPSMEAR
(04) PV12 - PAPSMEAR
(05) PV12 - PAPSMEAR
(06) PV12 - PAPSMEAR
(07) PV12 - PAPSMEAR
(08) PV12 - PAPSMEAR
(09) PV12 - PAPSMEAR
(10) PV12 - PAPSMEAR
(11) PV12 - PAPSMEAR
(12) PV12 - PAPSMEAR
(13) PV12 - PAPSMEAR
(14) PV12 - PAPSMEAR
(15) PV12 - PAPSMEAR
(16) PV12 - PAPSMEAR
(91) PV11 - MAMNOTHS
(-8) PV12 - PAPSMEAR
(-9) PV12 - PAPSMEAR

PV12 - PAPSMEAR
(01) BOX PV7
(02) PV13 - PAPCODE
(-8) BOX PV7
(-9) BOX PV7

(01) BOX PV7
(02) BOX PV7
(03) BOX PV7
(04) BOX PV7
(05) BOX PV7
(06) BOX PV7
(07) BOX PV7
(08) BOX PV7
(09) BOX PV7
(10) BOX PV7
(11) BOX PV7
(12) BOX PV7
(13) BOX PV7
(14) BOX PV7
(15) BOX PV7
(91) PV13 - PAPNOTHS
(-8) BOX PV7
(-9) BOX PV7

BOX PV7

Page 4 of 5

2023 MCBS Community Questionnaire

Variable Name

HYSTEREC

PROSSURG

PVQ-PREVENTIVE CARE

MR Screen Name Question Type

Question Text/Description

BOX PV7

IF RESPONDENT HAS NOT PREVIOUSLY REPORTED HYSTERECTOMY
(SAMPLE_PERSON.P_HYSTEREC^=1) AND RESPONSE TO PV13 – PAPCODE DOES NOT INCLUDE
14/HadHysterectomy, GO TO PV14 - HYSTEREC.
ELSE GO TO BOX PVEND.

routing

PV14

yes/no

BOX PV8

routing

PV15

yes/no

[Have you/Has (SP)] ever had a hysterectomy?
IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A PREVIOUS ROUND
(sample_person.P_PROSSURG=1), GO TO PV16 - DIGTEXAM.
ELSE GO TO PV15 - PROSSURG.
[Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)/[Have you/has (SP)] ever] had surgery on
(your/his) prostate?
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is typically used as a treatment for prostate cancer or to
correct urinary problems. Surgery can include complete or partial removal of the prostate.]

Code List

Routing

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

BOX PVEND

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

PV16 - DIGTEXAM

[These next few questions are about follow-up care sometimes prescribed after prostate surgery].

DIGTEXAM

PV16

yes/no

(01) YES
[Have you/Has (SP)] had a digital rectal examination (of the prostate) since (SAMPLE_PERSON.DATE_FALLRND)? (02) NO
(-8) DON'T KNOW
[EXPLAIN IF NECESSARY: The exam may be used to detect prostate cancer, to determine whether cancer has
(-9) REFUSED
spread beyond the prostate, and as part of follow-up care after prostate surgery.]
[Have you/Has (SP)] had a blood test for detection of prostate cancer, known as a PSA, since
(SAMPLE_PERSON.DATE_FALLRND)?

BLOODTST

PV17

yes/no

PSA = PROSTATE-SPECIFIC ANTIGEN
[EXPLAIN IF NECESSARY: The test may be used to detect prostate cancer, to determine whether cancer has
spread beyond the prostate, and as part of follow-up care after prostate surgery.]

PRONCODE

PV18

code all

What is the reason that [you have/(SP) has] not had a prostate blood test or PSA since
(SAMPLE_PERSON.DATE_FALLRND)?
CHECK ALL THAT APPLY.

PRONOTHS

PV18
BOX PVEND

verbatim text
routing

OTHER (SPECIFY)
GO TO CVQ.

PV17 - BLOODTST

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

(01) BOX PVEND
(02) PV18 - PRONCODE
(-8) BOX PVEND
(-9) BOX PVEND

(01) DIDN’T KNOW IT WAS NEEDED/NO
NEED/NOTHING WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A
DIFFERENT SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT
CANCER/COULD GET CANCER ANYWAY/TEST IS
USELESS
(04) NOT AT RISK FOR CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND
IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE BLOOD TESTS/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
LOCATION/TRANSPORTATION DIFFICULTY
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF TEST/INSURANCE DOESN’T COVER
COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) NEVER HEARD OF PSA
(13) APPOINTMENT SCHEDULED FOR FUTURE DATE
(14) PROSTATECTOMY/PROSTATE REMOVED
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX PVEND
(02) BOX PVEND
(03) BOX PVEND
(04) BOX PVEND
(05) BOX PVEND
(06) BOX PVEND
(07) BOX PVEND
(08) BOX PVEND
(09) BOX PVEND
(10) BOX PVEND
(11) BOX PVEND
(12) BOX PVEND
(13) BOX PVEND
(14) BOX PVEND
(91) PV18 - PRONOTHS
(-8) BOX PVEND
(-9) BOX PVEND

BOX PVEND

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