CMS-P-0015A Usual Source of Care

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

USUAL SOURCE OF CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after KNQ.

PLACEPAR

US1

yes/no

Is there a particular doctor or other health professional, or a clinic [you/(SP)] usually [go/goes] to when [you are/he
is/she is] sick or for advice about [your/his/her] health?

BOX USA

routing

IF (INTTYPE=7) AND SP ever reported speaking a language other than English in the home
(SAMPLE_PERSON.WHATLANG EQUALS 1-"SPANISH", 2-"FRENCH", 3-"GERMAN", OR 91-"Other, Specify")
AND P_ENGWELL=1, GO TO LEP6-LANGPROB.
ELSE GO TO US39 – NUSNOTSK.

(01) US2 - PLACEKND
(02) BOX USA
(-8) BOX USA
(-9) BOX USA

PLACEKND

US2

code one

(01) BOX USB
(02) BOX USB
(03) US3A - CLNAME
(04) US3A - CLNAME
(05) US3A - CLNAME
(06) US3A - CLNAME
What kind of place [do you/does (SP)] usually go to when [you are/he is/she is] sick or for advice about [your/his/her]
(07) US3A - CLNAME
health -- is that a managed care plan or HMO center, a clinic, a doctor or other health professional's office, a
(08) US3A - CLNAME
hospital, or some other place?
(09) US3A - CLNAME
(10) US5A - MDNAME
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind of clinic?
(11) US3A - CLNAME
IF SOME OTHER PLACE, ASK: Where is this?
(12) US3A - CLNAME
(13) US3A - CLNAME
(14) US3A - CLNAME
(91) US2 - PLACEOS
(-8) US3A - CLNAME
(-9) US3A - CLNAME

PLACEOS

US2

text

OTHER (SPECIFY)

BOX USB

routing

IF SP WAS COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO US2A
- PLACEMCP.
ELSE IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.

US2A

yes/no

Is this [doctor or other health professional/medical clinic] associated with [your/his/her] [READ MANAGED CARE
PLAN NAME(S) BELOW] plan?

BOX USC

routing

IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.

US3A

verbatim text

PLACEMCP

US3A - CLNAME

BOX USC

What is the complete name of the [place/managed care plan or HMO center/(US2 RESPONSE)] that [you go
to/(SP) goes to]?
CLNAME

US4 - USUALDOC
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]

Page 1 of 14

2024 MCBS Community Questionnaire

USQ-USUAL SOURCE OF CARE

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

USUALDOC

US4

yes/no

Is there a particular doctor or other health professional [you usually see/(SP) usually sees] at this [place/managed
care plan or HMO center/(US2 RESPONSE)]?

(01) US5A - MDNAME
(02) US7-INNOVATE BOX USD
(-8) US7-INNOVATE BOX USD
(-9) US7-INNOVATE BOX USD

MDNAME

US5A

verbatim text

MDSEX

US5B

code one

Routing

What is the complete name of that doctor or other health professional?
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]

Is (US5A PROVIDER NAME) a male or female?

MDSEX - US5B

US6A - PVSPEC

SHOW CARD US1
What is (US5A PROVIDER NAME)'s specialty?
PVSPEC

US6A

code one

[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]

(01)- (43) US7-INNOVATE
(91) US6A - MDSPECOS
(-8) US7-INNOVATE BOX USD
(-9) US7-INNOVATE BOX USD

OTHER DR SPECIALTY (SPECIFY)

MDSPECOS

US6A

text

[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]

BOX USD

Many health care providers are beginning to participate in innovative health care initiatives, programs, and payment
models. Is (US5A PROVIDER NAME)/(US3A PROVIDER NAME) associated with an innovative health care
initiative such as an accountable care organization or a patient centered medical home?
INNOVATE

US7

yes/no

[IF NEEDED: Innovative health care initiatives are programs that test ways to improve the delivery of health care,
improve the quality of health care, lower health care costs, and reduce health disparities.]

BOX USD

IF THE RESPONDENT DOESN'T KNOW WHAT INNOVATIVE HEALTH CARE INITATIVES ARE OR HAS NEVER
HEARD OF INNOVATIVE HEALTH CARE INITIATIVES, SELECT 'DON'T KNOW'.

BOX USD

routing

IF (INTTYPE=7) AND (SAMPLE_PERSON.WHATLANG EQUALS 1-"SPANISH", 2-"FRENCH", 3-"GERMAN", OR
91-"Other, Specify"), GO TO LEP1A-LANGPREF.
ELSE GO TO BOX US1.

LANGPREF

LEP1A

select one

In general, in what language [do you/does (SP)] prefer to receive [your/his/her] medical care?

(01) LEP4-LANGSYMP
(02) LEP2-LANGPRVD
(03) LEP2-LANGPRVD
(91) LEP1B-LANGPFOS
(-8) LEP2-LANGPRVD
(-9) LEP2-LANGPRVD

LANGPFOS

LEP1B

verbatim text

In general, in what language [do you/does (SP)] prefer to receive [your/his/her] medical care?

LEP2-LANGPRVD

Page 2 of 14

2024 MCBS Community Questionnaire

USQ-USUAL SOURCE OF CARE

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

LANGPRVD

LEP2

select one

(01) LEP3-LANGCOMM
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER NAME)] speak [LANGUAGE SPOKEN AT (02) LEP4-LANGSYMP
HOME/LEP1B-LANGPFOS]?
(-8) LEP4-LANGSYMP
(-9) LEP4-LANGSYMP

LANGCOMM

LEP3

select one

How well can [you/(SP)] and [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)] communicate BOX LEP1
in [LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS] about [your/his/her] symptoms? Very well, well, not well,
or not at all?

BOX LEP1

routing

IF P_ENGWELL=1, GO TO LEP6-LANGPROB. ELSE GO TO BOX US1.

Routing

SHOW CARD US2

SHOW CARD US2
LANGSYMP

LEP4

select one

Without the aid of a translator, language assistant, or interpreter, how well can [you/(SP)] and [(US5A PROVIDER
NAME)/the providers at (US3A PROVIDER NAME)] communicate in English about [your/his/her] symptoms? Very
well, well, not well, or not at all?

BOX LEP2

routing

IF P_ENGWELL=1, GO TO LEP5-LANGASST. ELSE GO TO BOX US1.

BOX LEP2

SHOW CARD US3

LANGASST

LEP5

select all

Who helps [you/(SP)] communicate with [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)] –
a professional interpreter, a staff person at [your/his/her] provider's office, a family member, a friend, [do you/does
LEP6-LANGPROB
(SP)] do the best that [you/(SP)] can in English, or does no one help [you/(SP)] because [you have/(SP) has] no
trouble communicating in English?
PROBE: Anyone else?

LANGPROB

LEP6

select one

Have [you/(SP)] ever had a problem understanding a medical situation because it was not explained in
[LANGAUGE SPOKEN AT HOME/LEP1B-LANGPFOS]?

LEP7-LANGHELP

SHOW CARD US3
Now think about all of [your/(SP)'s] medical providers other than [your/his/her] usual provider.
LANGHELP

LEP7

select all

Who helps [you/(SP)] communicate with medical providers who do not speak [LANGUAGE SPOKEN AT
HOME/LEP1B-LANGPFOS]– a professional interpreter, a staff person at [your/his/her] provider's office, a family
member, a friend, [do you/does (SP)] do the best that [you/(SP)] can in English, or does no one help [you/(SP)]
because [you have/(SP) has] no trouble communicating in English?

BOX US1

PROBE: Anyone else?

BOX US1

routing

IF US1 - PLACEPAR = NO, DK, or RF, GO TO US39 - NUSNOTSK.
ELSE IF US2 - PLACEKND = 10/AtHome, GO TO PP1A-PROVYR.
ELSE GO TO US8 - GETUSHOW.

Page 3 of 14

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S office/(US3A PROVIDER NAME)]?

Code List

(01) US9 - GETUSUNT
(02) US9 - GETUSUNT
(03) US9 - GETUSUNT
(04) US9 - GETUSUNT
(05) US9 - GETUSUNT
(06) US9 - GETUSUNT
(07) PP1A-PROVYR
(91) US8 - GETUSOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

GETUSHOW

US8

code one

GETUSOS

US8

verbatim text

SOME OTHER WAY (SPECIFY)

US9 - GETUSUNT

GETUSUNT

US9

code one

About how long does it usually take for [you/(SP)] to get there?

(01) US9 - GETUSHRS
(02) US9 - GETUSMIN
(03) US9 - GETUSHRS
(-8) US10 - ACCOMPUS
(-9) US10 - ACCOMPUS

GETUSHRS

US9

numeric

HOURS:

If US9 GETUSUNT=3/HoursAndMinutes go to US9 GETUSMIN.
Else go to US10 - ACCOMPUS.

GETUSMIN

US9

numeric

MINUTES:

US10 - ACCOMPUS

ACCOMPUS

US10

yes/no

[Do you/Does (SP)] usually have someone accompany [you/him/her] there?

(01) US11 - PERSON_USUALGO
(02) PP1A-PROVYR
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

[EXPLAIN IF NECESSARY: [Do you/Does (SP)] get there by walking, driving, being driven by someone else, by
ambulance or other special vehicle for disabled people, by taxi, other public transportation, or some other way?]

Routing

(01-N) US11AA-ACCREAS
(N+1) US11_NEW-ROSTFNAM
Who usually goes with [you/(SP)]?

PERSON_USUAL
US11
GO

roster

ROSTFNAM

US11_NEW

text

[What is the name of the person and relationship to (SP)?]

US11_NEW - ROSTLNAM

ROSTLNAM

US11_NEW

text

[What is the name of the person and relationship to (SP)?]

US11_NEW - ROSTREL

[What is the name of the person and relationship to (SP)?]

(01) DO NOT DISPLAY
(02) US11AA-ACCREAS
(56) US11AA-ACCREAS
(58) US11AA-ACCREAS
(59) US11AA-ACCREAS
(60) US11AA-ACCREAS
(61) US11AA-ACCREAS
(91) US11_NEW - ROSTREOS
(-8) US11AA-ACCREAS
(-9) US11AA-ACCREAS

ROSTREL

US11_NEW

SELECT OR ADD ONLY ONE PERSON

code one

IF EXISTING PERSON SELECTED, GO TO US11AAACCREAS.
ELSE IF "ADD ANOTHER" SELECTED, GO TO
US11_NEW-ROSTFNAM

Page 4 of 14

2024 MCBS Community Questionnaire

USQ-USUAL SOURCE OF CARE

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

ROSTREOS

US11_NEW

verbatim text

[What is the name of the person and relationship to (SP)?]

US11AA-ACCREAS

ACCREAS

US11AA

code all

(01) PP1A-PROVYR
(02) PP1A-PROVYR
(03) PP1A-PROVYR
(04) PP1A-PROVYR
What are the reasons [you accompany (SP)/this person accompanies you/this person accompanies this person] do?
(05) PP1A-PROVYR
(06) PP1A-PROVYR
[PROBE: Any other reason?]
(07) PP1A-PROVYR
(08)PP1A-PROVYR
CHECK ALL THAT APPLY.
(09) PP1A-PROVYR
(91) US11AA - ACCOTHOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR

ACCOTHOS

US11AA

verbatim text

OTHER (SPECIFY)

PROVYR

PP1A

code one

[Have you/Has (SP)] seen [(US5A PROVIDER NAME)/(US3A PROVIDER NAME)] in the last 12 months?
INCLUDE TELEMEDICINE VISITS.

The next questions ask about the care [you/(SP)] received from [(US5A PROVIDER NAME)'S office/(US3A
PROVIDER NAME)].
REMINDAPPT

PP1

yes/no

PREAPPT

PP2

yes/no

Some offices remind patients about appointments. Before [your/(SP)'s] most recent visit with [(US5A PROVIDER
NAME)/(US3A PROVIDER NAME) ], did [you/he/she] get a reminder from [(US5A PROVIDER NAME)'S office
/(US3A PROVIDER NAME)] about the appointment?

Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)'s office/(US3A PROVIDER NAME)], did
[you/he/she] get instructions telling [you/him/her] what to expect or how to prepare?

Routing

PP1A-PROVYR

(01) PP1-REMINDAPPT
(02) US27-USCKEVRY
(-8) US27-USCKEVRY
(-9) US27-USCKEVRY

(01) PP2- PREAPPT
(02) PP2- PREAPPT
(996) PP4-MISSAPPT
(-8) PP2- PREAPPT
(-9) PP2- PREAPPT

PP4-MISSAPPT

SHOW CARD US4

MISSAPPT

PP4

code one

(01) PP8-DOCHLTH
Now I’m going to read you questions about the medical providers [you have/SP has] seen in the last twelve months, (02) PP5- NEWAPPT
that is since {TODAY'S MONTH AND YEAR - 12 MONTHS}.
(03) PP5-NEWAPPT
(04) PP5- NEWAPPT
People have busy lives and miss appointments for many reasons. Since (TODAY'S MONTH AND YEAR-12
(-8) PP8-DOCHLTH
MONTHS), how often did [you/(SP)] miss an appointment with [(US5A PROVIDER NAME)/(US3A PROVIDER
(-9) PP8-DOCHLTH
NAME)]?

SHOW CARD US4
NEWAPPT

PP5

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [ you/(SP)] missed an appointment with US5A
PROVIDER NAME/US3A PROVIDER NAME), how often did someone from [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)] contact [you/him/her] to make a new appointment?

PP8-DOCHLTH

SHOW CARD US4
DOCHLTH

PP8

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] ask about things in [your/(SP)'s] work or life at home that affect
[your/(SP)'s] health?

PP9- DOCEASY

Page 5 of 14

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

DOCEASY

PP9

code one

DOCLSTN

PP10

code one

DOCRSPCT

PP11

code one

ENUFTIME

PP12

code one

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] explain things in a way that was easy [for (SP)] to understand?

PP10-DOCLSTN

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] listen carefully to [you/(SP)]?

PP11-DOCRSPCT

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] show respect for what [you/(SP)] had to say?

PP12- ENUFTIME

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] spend enough time with [you/(SP)]?

PP13- HLTHIDEA

SHOW CARD US4
HLTHIDEA

PP13

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] ask whether [you/(SP)] had ideas about how to improve [your/his/her]
health?

SHOW CARD US5
STHLTHGL

PP15

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] talk with [you/(SP)] about setting goals for [your/his/her] health?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

PP15-STHLTHGL

(01) PP16- MTHLTHGL
(02) PP16- MTHLTHGL
(03) US27-USCKEVRY
(-8) US27-USCKEVRY
(-9) US27-USCKEVRY

SHOW CARD US5
MTHLTHGL

PP16

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did the care [you/(SP)] received from [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)] help [you/(SP)] meet [your/his/her] goals?

US27-USCKEVRY

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US6

USCKEVRY

US27

list

Now I am going to read some statements people have made about their health care. Think about the care [you
receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each statement, please tell
me whether you strongly agree, agree, disagree, or strongly disagree.

US27-USUNWRNG

[(US5A PROVIDER NAME) is/The doctors or other health professionals at (US3A PROVIDER NAME) are] very
careful to check everything when examining [you/him/her].

Page 6 of 14

2024 MCBS Community Questionnaire

USQ-USUAL SOURCE OF CARE

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

USUNWRNG

US27

list

BOX US4

routing

IF PP1A-PROVYR= 01/YES, GO TO PP17 OTHRSTFF.
ELSE GO TO BOX US5.

OTHRSTFF

PP17

yes/no

People often get instructions about their health from more than one person in the same office, such as other medical
(01) PP18- OSUPTODT
providers, nurses, nutritionists, and social workers.
(02) PP21- ORDRTEST
(-8) PP21- ORDRTEST
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get any instructions about your health from any
(-9) PP21- ORDRTEST
other staff [in (US5A PROVIDER NAME)'s office/ at (US3A PROVIDER NAME)]?

OSUPTODT

PP18

code one

Routing

SHOW CARD US6
[(US5A PROVIDER NAME) has/The doctors or other health professionals at (US3A PROVIDER NAME) have] a
complete understanding of the things that are wrong with [you/him/her].

BOX US4

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other staff seem up-to-date about the care PP19- OSTLKCR
[you were/(SP) was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)]?

SHOW CARD US4
OSTLKCR

PP19

code one

OSNOINFO

PP20

code one

ORDRTEST

PP21

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other staff talk with [you/(SP)] about care
[you/he/she] [were/was] receiving from [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER
NAME)]?

PP20- OSNOINFO

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did these other staff seem to know the important
information about [your/(SP)'s] medical history?

PP21- ORDRTEST

The next set of questions ask about the care you received from [(US5A PROVIDER NAME)/the medical providers at
(01) PP22- TSTFLWUP
(US3A PROVIDER NAME)] or someone in [his/her/their] office.
(02) PP29-HLTHSRVC
(-8) PP29-HLTHSRVC
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(-9) PP29-HLTHSRVC
(US3A PROVIDER NAME)] or someone in [his/her/their] office order a blood test, x-ray, or other test for [you/(SP)]?

SHOW CARD US4
TSTFLWUP

PP22

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] or someone from [his/her/their] office ordered a blood test, x-ray, or other test for
[you/(SP)], how often did [(US5A PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] or
someone from [his/her/their] office follow up to give [you/(SP)] those results?

PP23-RQSTRSLT

Page 7 of 14

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

RQSTRSLT

PP23

code one

RSLTEASY

PP24

code one

HLTHSRVC

PP29

yes/no

SRVCHELP

PP30

code one

GIVEINST

PP31

yes/no

ANYRX

PP35

yes/no

TALKRX

PP36

code one

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [you/(SP)] have to request [your/his/her] test
results before [you/he/she] got them?

PP24- RSLTEASY

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often were [your/(SP)'s] test results presented in a way
that was easy to understand?

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need services at home to help [you/him/her]
take care of [your/his/her] health?

PP29-HLTHSRVC

(01) PP30- SRVCHELP
(02) PP31- GIVEINST
(-8) PP31- GIVEINST
(-9) PP31- GIVEINST

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office help [you/(SP)] get these services at
home to take care of [your/his/her] health?

PP31- GIVEINST

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] or someone in [his/her/their] office give [you/(SP)] instructions about how to take care of PP35-ANYRX
[your/his/her] health?

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] take any prescription medicine?
[THIS IS DIFFERENT FROM THE PRESCRIPTION DRUG WHERE WE ASK IF THE R HAD ANY
PRESCRIPTIONS FILLED]

(01) PP36- TALKRX
(02) BOX US5
(-8) BOX US5
(-9) BOX US5

SHOW CARD US4
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office talk with [you/(SP)] about how [you
were/he was/she was] supposed to take [your/his/her] medicine?

PP37- ASPRSCBD

SHOW CARD US4
ASPRSCBD

PP37

code one

There are many reasons why people may not always be able to take their medicines as prescribed.
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often [were you/was (SP)] able to take [your/his/her]
medicine as prescribed?

PP38-BADRCTN

SHOW CARD US4
BADRCTN

PP38

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] or someone in [his/her/their] office talk with [you/(SP)] about what to do if
[you have/he has/she has] a bad reaction to [your/his/her] medicine?

BOX US5

Page 8 of 14

2024 MCBS Community Questionnaire

Variable Name

USQ-USUAL SOURCE OF CARE

MR Screen Name Question Type

Question Text/Description

BOX US5

GO TO US37A CARESPCL.

routing

Code List

Routing

SHOW CARD US1

CARESPCL

US37A

yes/no

Specialists are doctors or other health professionals who specialize in one area of health care. This card lists some
examples of specialists.
Since (TODAY'S MONTH AND YEAR-12 MONTHS) , did [you/(SP)] receive care from any specialists outside the
office of [(US5A PROVIDER NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)]?

(01) US37B - DRINFRMD
(02) PP50-HOSADMIT
(-8) PP50-HOSADMIT
(-9) PP50-HOSADMIT

SHOW CARD US4
DRINFRMD

US37B

code one

REMINDDR

US37C

code one

STPMSPCL

US37D

yes/no

TALKPMS

US37E

code one

In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (US3A
PROVIDER NAME)] seem informed and up-to-date about the care [you get/(SP) gets] from specialists?

US37C - REMINDDR

SHOW CARD US4
In general, how often [do you/does(SP)] have to remind [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] about care [you receive/(SP) receives] from specialists?

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did any specialists outside the office of [(US5A PROVIDER
NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)] prescribe medicine for [you/(SP)]?

US37D - STPMSPCL

(01) US37E - TALKPMS
(02) US37E1 - NAMESPCL
(-8) US37E1 - NAMESPCL
(-9) US37E1 - NAMESPCL

SHOW CARD US4
In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (US3A
PROVIDER NAME)] talk with [you/(SP)] about the medicines prescribed by these specialists?

US37E1 - NAMESPCL

The next four questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often in the
last 12 months outside the office of [(US5A PROVIDER NAME)/the doctors or other health professionals at (US3A
PROVIDER NAME)].
NAMESPCL

US37E1

verbatim text

First, what is the name of the specialist [you/(SP)] saw most often since (TODAY'S MONTH AND YEAR-12
MONTHS)?

US37E2 - SEXSPCL

[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT CARD,
ETC., FOR COMPLETE INFORMATION.]

SEXSPCL

US37E2

code one

Is [(US37E1 PROVIDER NAME)/the specialist you saw most often since (TODAY'S MONTH AND YEAR-12
MONTHS)] a male or female?

US37F - KNOWSPCL

Page 9 of 14

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

SHOW CARD US5
[IF NEEDED: This question is about the last twelve months, that is since (TODAY'S MONTH AND YEAR - 12
MONTHS).]

KNOWSPCL

US37F

code one

The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often in the last
twelve months outside the [office of (US5A PROVIDER NAME)/the doctors or other health professionals at (US3A
PROVIDER NAME)].

US37G - RPTINFO

When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], does [he/she/he or she] seem to know enough
information about [your/his/her] medical history?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US4
RPTINFO

US37G

code one

When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often [do you/does (SP)] have to repeat
information that [you/he/she] [have/has] already given to [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)]?

KNOWRSLT

SHOW CARD US4

KNOWRSLT

PP49

code one

The next questions ask about care [you/(SP)] received from the specialist [you/he/she] saw most often since
(TODAY'S MONTH AND YEAR-12 MONTHS) outside the [office of (US5A PROVIDER NAME)/the doctors or other
health professionals at (US3A PROVIDER NAME)].

PP50-HOSADMIT

When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often does [he/she/he or she] seem to know
[your/(SP)'s] important test results from other providers?

(01) PP51- HOSFLWUP
(02) PP58- MNGCARE
(-8) PP58- MNGCARE
(-9) PP58- MNGCARE

HOSADMIT

PP50

yes/no

Since (TODAY'S MONTH AND YEAR-12 MONTHS), [were you/was (SP)] admitted to a hospital overnight or
longer?

HOSFLWUP

PP51

yes/no

After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office contact [you/him/her] to see how [you were/he was/she was] PP52- HOSMED
doing?

HOSMED

PP52

yes/no

After [your/(SP)'S] most recent hospital stay, [were you/was (SP)] prescribed any medicines?

(01) PP53- HOSFOLLOWUP
(02) PP54- HOSINSTU
(-8) PP54- HOSINSTU
(-9) PP54- HOSINSTU

HOSFOLLOWUP

PP53

yes/no

After (your/(SP)'s)] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] or someone in [his/her/their] office contact [you/SP] to check if [you were/he was/she was ]
able to follow instructions about any medicines [you were/he was/she was] prescribed?

PP54- HOSINSTU

HOSINSTU

PP54

yes/no

After (your/(SP)'s] most recent hospital stay, (were you/was he/was she] given instructions about caring for
[yourself/himself/herself] at home?

(01) PP55- INSTUEASY
(02) PP56- HOSINFO
(-8) PP56- HOSINFO
(-9) PP56- HOSINFO

Page 10 of 14

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

INSTUEASY

PP55

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

Routing

SHOW CARD US5
code one

After [your/(SP)'s] most recent hospital stay, were the instructions [you were/(SP) was] given easy to understand?

PP56- HOSINFO

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

HOSINFO

PP56

code one

SHOW CARD US5
After (your/(SP)'s) most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] seem to know the important information about this hospital stay?

PP58-MNGCARE

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US7
People sometimes need to manage their medical care by making appointments with multiple providers, following
their instructions, and taking medicines as prescribed.
MNGCARE

PP58

code one

Using any number from 0 to 10, where 0 is hard and 10 is easy, what number would you use to rate how easy it was
for [you/(SP)] to manage [your/his/her] medical care since (TODAY'S MONTH AND YEAR-12 MONTHS)?

PP58A-DOCCARE

[IN SITUATIONS WHERE A PROXY OR SOMONE ELSE MANAGES THE RESPONDENT’S MEDICAL CARE
FOR OR WITH THEM, ANSWER BASED ON THEIR EXPERIENCE.]

DOCCARE

PP58A

code one

GETHELP

PP58B

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need help from [anyone in (US5A PROVIDER
NAME)'s office/the doctors or other health professionals at (US3A PROVIDER NAME)] to manage [your/his/her]
care among these different providers and services?

(01) PP58B-GETHELP
(02) PP59-ONEDOC
(-8) PP59-ONEDOC
(-9) PP59-ONEDOC

SHOW CARD US5
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get the help [you/he/she] needed from [(US5A
PROVIDER NAME)'s office/the doctors or other health professionals at (US3A PROVIDER NAME)] to manage
[your/his/her] care among these different providers and services?

PP59-ONEDOC

SHOW CARD US5
ONEDOC

PP59

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider who knew about all [your/(SP)'s]
medical care needs?

PP60- PRVNOMED

[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]

SHOW CARD US5
Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider who knew about all the medicines [you
were/(SP) was] taking?
PRVNOMED

PP60

code one

BOX US7
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
IF THE RESPONDENT WAS NOT TAKING ANY MEDICINES, PROBE IF THERE WAS ONE PROVIDER WHO
KNEW THAT.

Page 11 of 14

2024 MCBS Community Questionnaire

Variable Name

NOTAVAIL

COMPUSE

USQ-USUAL SOURCE OF CARE

MR Screen Name Question Type

Question Text/Description

BOX US7

routing

GO TO US37I- NOTAVAIL

US37I

code one

Since (TODAY'S MONTH AND YEAR-12 MONTHS), when getting care for a medical problem, was there ever a
time when test results, medical records, or reasons for referrals were not available at the time of [your/(SP)’s]
scheduled doctor or other health professional appointment?

BOX EHR1

routing

IF US1-PLACEPAR=1, GO TO EHR2-COMPUSE,
ELSE GO TO BOX USEND.

EHR2

yes/no

The next few questions will help us understand how [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] use(s) a computer during [your/(SP)'s] office visit. Please answer the
following questions based on where [you go/(SP) goes] for medical care most of the time.
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER NAME)] use a computer during
[your/(SP)'s] office visit?

Many health care providers are beginning to use electronic or computer-based medical records instead of using
paper-based records. When [you visit/(SP) visits] [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] [does he or she/do they] generally enter [your/(SP)'s] health information
into a computer while [you are/(SP) is] present?
EMEDREC

US37K

yes/no

[IF SUPPORT STAFF (NURSES, MEDICAL ASSISTANTS) ENTER INFORMATION INTO THE ELECTRONIC
HEALTH RECORD DURING THEIR VISIT, SELECT “YES” AT THIS QUESTION.]

Code List

Routing

BOX EHR1

(01) US37K - EMEDREC
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD

(01) EHR3-COMPSHW
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD

[EXPLAIN IF NECESSARY: An “electronic health record” is an electronic version of a patient’s medical history
maintained by a provider over time. It automates the way in which doctors can access patient health information.
"Health Information" includes information such as symptoms, vital signs, test results, or prescribed medicines.]

COMPSHW

EHR3

yes/no

Is the examination room set up so that [(US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME)] can easily show [you/(SP)] information on the computer screen?

(01) EHR4-COMPINFO
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD

COMPINFO

EHR4

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] use
the computer to show [you your/(SP) his/(SP) her] health information during [your/his/her] visit, such as trends in
blood pressure reading, height, weight and body mass index, previous lab results, x-rays/images, immunizations or
medications?

(01) EHR5-COMPREC
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD

COMPREC

EHR5

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] use
the computer to show [you/(SP)] recommendations for preventive health screenings or other medical services?

EHR6-COMPRD

COMPRD

EHR6

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] read
back to [you/(SP)] information that [you have/(SP) has] given during [your/(SP)'s] visit that is being put into
[your/(SP)'s] medical record?

EHR7-COMPINF

COMPINF

EHR7

yes/no

[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)] send
[you/(SP)] health information electronically, such as information about [your/(SP)'s] medications, exercise plans,
dietary advice, etc.?

EHR8-COMPACC

Page 12 of 14

2024 MCBS Community Questionnaire

USQ-USUAL SOURCE OF CARE

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

COMPACC

EHR8

yes/no

[Does (US5A PROVIDER NAME)'s/Do the doctors or other health professionals at (US3A PROVIDER NAME)'s]
office give [you/(SP)] access through [your/(SP)'s] own computer or smart phone to parts or all of [your/(SP)'s]
BOX EHR2
electronic medical record (such as a list of [your/(SP)'s] medications, lab results, x-ray reports, office notes) through
a “patient portal” or other electronic system?

BOX EHR2

routing

IF EHR2-COMPUSE=(01) YES, GO TO EHR9-COMPHLP,
ELSE GO TO BOX USEND

Routing

SHOW CARD US6

COMPHLP

EHR9

list

Now I am going to read some statements people have made about how their provider uses a computer. Think about
the care [you receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each
EHR9-COMPDIST
statement, please tell me whether you strongly agree, agree, disagree, or strongly disagree.
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME) use of the
computer during [my/(SP)'s] visit is helpful to [me/(SP)].

SHOW CARD US6
COMPDIST

EHR9

list

COMPATT

EHR9

list

(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME) use of the
computer during [my/(SP)'s] visit distracts [him/her/them] from paying attention to [me/(SP)].

EHR9-COMPATT

SHOW CARD US6
[(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME)] use of the
computer during [my/(SP)'s] visit distracts [me/(SP)] from paying attention to the clinician.

EHR10-COMPTM

SHOW CARD US8

COMPTM

EHR10

code one

For the next statement, please tell me if it's much more than it should be, somewhat more than it should be, about
what it should be, somewhat less than it should be, much less than it should be, or no opinion?

BOX USEND

The amount of time during the visit that (US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME) spend(s) on the computer seems:

I am going to read some reasons that people have given for not having a usual source of health care. For each
one, please tell me whether or not it is a reason [you do/(SP) does] not have a usual place for health care.
NUSNOTSK

US39

list

US39 - NUSMOVIN
There is no reason to have a usual source of health care because [you/(SP)] seldom or never [get/gets] sick. [Is that
a reason [you do/(SP) does] not have a usual source of health care?]

NUSMOVIN

US39

list

[You/(SP)] recently moved into the area. [Is that a reason [you do/(SP) does] not have a usual source of health
care?]

NUSAVAIL

US39

list

(01) US42 - USWHYNAV
[Your/(SP’s)] usual source of health care in this area is no longer available. [Is that a reason [you do/(SP) does] not (02) US43 - NUSDIFFP
have a usual source of health care?]
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP

US39 - NUSAVAIL

Page 13 of 14

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

USQ-USUAL SOURCE OF CARE

Question Text/Description

Code List

USWHYNAV

US42

code one

Why is [your/(SP’s)] usual source of health care no longer available?

(01) US43 - NUSDIFFP
(02) US43 - NUSDIFFP
(03) US43 - NUSDIFFP
(04) US43 - NUSDIFFP
(05) US43 - NUSDIFFP
(91) US42 - USWHYNO1
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP

USWHYNO1

US42

verbatim text

OTHER (SPECIFY)

US43 - NUSDIFFP

NUSDIFFP

US43

list

Routing

Thinking about other possible reasons that people have for not having a usual source of health care, please tell me
if this statement applies to [you/(SP)]:
US43 - NUSTOOFR
[You like/(SP) likes] to go to different places for different health care needs. [Is that a reason [you do/(SP) does] not
have a usual source of health care?]

NUSTOOFR

US43

list

The places where [you/(SP)] can receive health care are too far away. [Is that a reason [you do/(SP) does] not have
US43 - NUSTOOEX
a usual source of health care?]

NUSTOOEX

US43

list

The cost of health care is too expensive. [Is that a reason [you do/(SP) does] not have a usual source of health
care?]

BOX USEND

routing

GO TO TLQ

BOX USEND

Page 14 of 14