CMS-P-0015A Preventive Care

2025 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 SEASON=FALL, administer after MBQ.
If SEASON=WINTER or SUMMER, administer after HIQ

PVINTRO

FLUSHOT

BOX PVBEG

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
PVINT-PVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1-FLUSHOT=1/YES), GO TO BOX
PV4 BOX PVEND.

PVINT

No entry

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."

PVF1

yes/no

BOX PV1

routing

Since [July 1st, (ROUND 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

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

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

(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 AFFORD 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/ALLERGY/MEDICAL REASON THAT
PREVENT ME FROM GETTING THE VACCINE
(20) I DON'T TRUST WHAT GOVERNMENT SAYS
ABOUT VACCINE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(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

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

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

PVF1-FLUSHOT

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

Page 1 of 7

2025 MCBS Community Questionnaire

PVQ-PREVENTIVE CARE

Variable Name

MR Screen Name

Question Type

Question Text/Description

FLUOTHOS

PVF2

verbatim text

OTHER (SPECIFY)

BOX PV2

routing

IF MORE THAN ONE RESPONSE SELECTED AS YES AT PVF2-FLUCODE, GO TO PVF3-PVFLU3, ELSE GO
TO BOX PV3

Code List

Routing
BOX PV2

PVF3

code one

[LIST ALL RESPONSES SELECTED AT PVF2FLUCODE]
_ _ [ENTER MAIN REASON]
READ LIST TO RESPONDENT. IF RESPONDENT SELECTS MORE THAN ONE REASON PROBE FOR MAIN
(-8) DON’T KNOW
REASON.
(-9) REFUSED

BOX PV3

routing

IF RESPONSE TO PVF2-FLUCODE DOES NOT INCLUDE 15, GO TO PVF5-VACAVAIL..
ELSE GO TO BOX PV4 BOX PVEND.

Of the reasons you listed, what is the main reason [you/(SP)] did not get a flu vaccination this flu season?
PVFLU3

FLUSITE

FLUSITE

code one

FLUSITOS

FLUSITOS

verbatim text

VACPAID

VACAVAIL

VACPAID

PVF5

BOX PV4

SHINGVAC

PV6

yes/no

yes/no

routing

yes/no

Where did [you/(SP)] go for [your/(SP)'s] 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?]

(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

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.

BOX PV3

(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

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/(SP)] wanted to because the vaccine was
in short supply or unavailable?

(01) YES
(02) NO
(-8) DON'T KNOW
[IF NEEDED: This question is asking about whether the seasonal flu shot was available to [you/(SP)], regardless
(-9) REFUSED
if [you/(SP)] did not receive or want one.]

PVF5-VACAVAIL

BOX PV4 BOX PVEND

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 available for shingles; Zostavax®, which requires 1 shot, and Shingrix®, a new vaccine which requires 2
shots.
[Have you/Has (SP)] had a vaccine for Shingles?

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

BOX PVEND

Page 2 of 7

2025 MCBS Community Questionnaire

Variable Name

PVQ-PREVENTIVE CARE

MR Screen Name

Question Type

Question Text/Description

BOX PV5

routing

IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE PNEUMONIA
VACCINE (P_PNEUSHOT^=1), GO TO PV7-PNEUSHOT.
ELSE GO TO BOX PVEND.
[Have you/Has (SP)] EVER had a pneumonia shot?

PNEUSHOT

PV7

yes/no

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®.

PREVHLTHINTRO

PV8

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 Medicare for 12 months, Medicare pays for “Annual Wellness” visits. These visits are yearly
appointments with the beneficiary’s primary care provider to update their personalized prevention plan.

WELLNESS

PV8A

Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had either a “Welcome to Medicare” or an
“Annual Wellness” visit?

BPTAKEN

BCTAKEN

BASKORAL

CASKORAL

OCCEXAM

Code List

Routing

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

BOX PVEND

(01) CONTINUE
(-7) EMPTY

PV8A- WELLNESS

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

PV9-BPTAKEN

code one

(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
SHOW CARD PV1
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
When was the most recent time [your/(SP)'s] blood pressure was taken by a doctor or other health professional?
(06) NEVER HAD BLOOD PRESSURE TAKEN
(-8) DON'T KNOW
(-9) REFUSED

PV10

code one

(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

BOX PV5A

routing

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

yes/no

(01) YES
[Have you/Has SP] ever had an exam for oral cancer in which the doctor or dentist pulls on [your/(SP)'s] tongue, (02) NO
sometimes with gauze wrapped around it, and feels under the tongue and inside the cheeks?
(-8) DON'T KNOW
(-9) REFUSED

yes/no

Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has SP] had an exam for oral cancer in which the
doctor or dentist pulls on [your/(SP)'s] tongue, sometimes with gauze wrapped around it, and feels under the
tongue and inside the cheeks?

PV9

PV10A

PV10B

PV10C

code one

BOX PV5C

routing

SHOW CARD PV2
When was the most recent time [your/(SP)'s] cholesterol was checked?

When was [your/(SP)'s] most recent oral or mouth cancer exam?
Was it within the past year, between 1 and 3 years ago, or over 3 years ago?

PV10 - BCTAKEN

BOX PV5A

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

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

BOX PV5C

(01) WITHIN THE PAST YEAR
(02) BETWEEN 1 AND 3 YEARS AGO
(03) OVER 3 YEARS AGO
(-8) DON'T KNOW
(-9) REFUSED

BOX PV5C

ELSE IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO PV19-BTSTHIV.
ELSE GO TO PV20-CTSTHIV.

Page 3 of 7

2025 MCBS Community Questionnaire

Variable Name

BTSTHIV

RCNTHIV

CTSTHIV

MR Screen Name

PV19

PV21

PVQ-PREVENTIVE CARE

Question Type

Question Text/Description

yes/no

(01) YES
The next question is about the test for HIV, the virus that causes AIDS. Except for tests [you/(SP)] may have had (02) NO
as part of blood donations, [have you/has (SP)] ever been tested for HIV?
(-8) DON'T KNOW
(-9) REFUSED

code one

When was [your/(SP)'s] most recent HIV test?

MAMMOGRM

(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

PV20

(01) YES
The next question is about the test for HIV, the virus that causes AIDS. Except for tests [you/(SP)] may have had
(02) NO
as part of blood donations, since (SAMPLE_PERSON.DATE_FALLRND) [have you/has (SP)] been tested for
(-8) DON'T KNOW
HIV?
(-9) REFUSED

BOX PV5D

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO PV22-WHYNHIV
ELSE GO TO BOX PV6

SHOW CARD PV3
WHYNHIV

Code List

PV22

code one

BOX PV6

routing

PV11

yes/no

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?

Routing
(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

(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
BOX PV6
(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

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

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

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX PV7
(02) PV11 - MAMCODE
(03) BOX PV7
(-8) BOX PV7
(-9) BOX PV7

Page 4 of 7

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

PVQ-PREVENTIVE CARE

Question Text/Description

Code List

Routing

(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
LOCATION/TRANSPORTATION DIFFICULTY
(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

(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
(16) BOX PV7
(91) PV11 - MAMNOTHS
(-8) BOX PV7
(-9) BOX PV7

MAMCODE

PV11

code all

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

MAMNOTHS

PV11

verbatim text

OTHER (SPECIFY)

BOX PV7

routing

IF RESPONDENT HAS NOT PREVIOUSLY REPORTED HYSTERECTOMY
(SAMPLE_PERSON.P_HYSTEREC^=1), GO TO PV14 - HYSTER
ELSE GO TO BOX PVEND.

HYSTER

PAPTEST

PV14

PV12

yes/no

yes/no

BOX PV7

[Have you/Has (SP)] ever had a hysterectomy?

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX PVEND
(02) PV12 - PAPTEST
(03) PV12 - PAPTEST
(-8) PV12 - PAPTEST
(-9) PV12 - PAPTEST

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

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) DON'T KNOW
(-9) REFUSED

(01) BOX PVEND
(02) PV13 - PAPREASN
(03) BOX PVEND
(-8) BOX PVEND
(-9) BOX PVEND

Page 5 of 7

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

PVQ-PREVENTIVE CARE

Question Text/Description

Code List

Routing

(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
(15) TOO ILL, PHYSICALLY/MENTALLY
(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
(15) BOX PVEND
(91) PV13 - PAPOTHR
(-8) BOX PVEND
(-9) BOX PVEND

PAPREASN

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.

PAPOTHR

PV13

verbatim text

OTHER (SPECIFY)

BOX PV8

routing

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.

PROSSURG

PV15

yes/no

BOX PVEND

[Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)/[Have you/has (SP)] ever] had surgery on
[your/(SP)'s] prostate?

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is typically used as a treatment for prostate cancer or (-8) DON'T KNOW
to correct urinary problems. Surgery can include complete or partial removal of the prostate.]
(-9) REFUSED

PV16 - DIGTEXAM

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

PV16

yes/no

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-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 digital rectal examination (of the prostate) since
(SAMPLE_PERSON.DATE_FALLRND)?

[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.]

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) DON'T KNOW
(-9) REFUSED

PV17 - BLOODTST

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

Page 6 of 7

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

PVQ-PREVENTIVE CARE

Question Text/Description

Code List

Routing

(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

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

verbatim text

OTHER (SPECIFY)

BOX PVEND

routing

GO TO CVQ.

BOX PVEND

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