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pdf2025 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
Page 7 of 7
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2024-06-26 |
| File Created | 2024-06-26 |