CMS-P-0015A HFQ - Health Status and Functioning

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED

HFA2 - COMPHLTH

(01) much better now than one year ago,
(02) somewhat better now than one year ago,
(03) about the same,
(04) somewhat worse now than one year ago, or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED

HFA2B - FUTRHLTH

(01) it will get much better
(02) it will get somewhat better
(03) it will not change
(04) it will get somewhat worse
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED

TEETHGUM- TEETHGUM

(01) excellent,
(02) very good,
(03) good,
(04) fair,
(04) or poor?
(-8) DON'T KNOW
(-9) REFUSED

DIS1 - DISHEAR

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

DIS2 - DISSEE

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

BOX HF1

DIS3 - DISDECISION

HEALTH STATUS AND FUNCTIONING QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C003, C004, C005, C006), administer after PVQ.
BOX HFBEG

GENHELTH

HFA1

routing

code one

GO TO HFA1 - GENHELTH

In general, compared to other people [your/(SP's)] age, would you say that [your/(SP's)] health is . . .

SHOW CARD HF1
COMPHLTH

HFA2

code one

Compared to one year ago, how would you rate [your/(SP's)] health in general now?
Would you say [your/(SP's)] health is . . .

FUTRHLTH

TEETHGUM

DISHEAR

DISSEE

DISTEETH

DISDECISION

DISWALK

DISBATH

HFA2B

TEETHGUM

DIS1

code one

code one

yes/no

SHOW CARD HF2
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?

In general, how would you rate the health of [your/(SP)'s] teeth and gums? Would you say . . .

Now, I would like to ask you about [your/(SP's)] health.
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?

DIS2

yes/no

[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing glasses or
contact lenses?

BOX HF1

routing

IF P_DISTEETH=YES, GO TO DIS3-DISDECISION.
ELSE GO TO DIS2A-DISTEETH.

DIS2A

DIS3

DIS4

DIS5

yes/no

[Have you/Has (SP)] lost all of [your/(SP's)] upper and lower natural (permanent) teeth?

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

yes/no

Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty concentrating,
remembering, or making decisions?

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

DIS4 - DISWALK

[Do you/Does (SP)] have serious difficulty walking or climbing stairs?

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

DIS5 - DISBATH

[Do you/Does (SP)] have difficulty dressing or bathing?

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

DIS6 - DISERRANDS

yes/no

yes/no

Page 1 of 38

2025 MCBS Community Questionnaire

Variable Name
DISERRANDS

HELMTACT

MR Screen Name
DIS6

HFA3

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

yes/no

Because of a physical, mental, or emotional condition, [do you/does (SP)] have difficulty doing errands alone
such as visiting a doctor's office or shopping?

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

HFA3 - HELMTACT

(01) none of the time,
(02) some of the time,
(03) most of the time, or
(04) all of the time?
(-8) DON'T KNOW
(-9) REFUSED

HFB1-ECHELP

(01) YES
(02) NO
(03) SP IS BLIND
(-8) DON'T KNOW
(-9) REFUSED

(01) HFB2 - ECTROUB
(02) HFB2 - ECTROUB
(03) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM

(01) NO TROUBLE SEEING
(02) A LITTLE TROUBLE SEEING
(03) A LOT OF TROUBLE SEEING
(04) NO USABLE VISION
(-8) DON'T KNOW
(-9) REFUSED

(01) HFB6 - EDOCEXAM
(02) HFB6 - EDOCEXAM
(03) HFB2A - ECLEGBLI
(04) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM

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

HFB6 - EDOCEXAM

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

(01) HFB7A - EDOCTYPE
(02) BOX HFC
(-8) BOX HFB1
(-9) BOX HFB1

(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
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

(996) BOX HFB1
(01) - (12) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1

(01) OPTOMETRIST
(02) OPHTHALMOLOGIST
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED

(01) H7B7B - EDOCDLAT
(02) H7B7B - EDOCDLAT
(91) HFB7 - EDOCTYOS
(-8) BOX HFB1
(-9) BOX HFB1

code one

How much of the time during the past month has [your/(SP's)] health limited [your/(SP's)] social activities, like
visiting with friends or close relatives?
Would you say . . .

ECHELP

ECTROUB

HFB1

HFB2

yes/no

code one

Next we are going to ask some questions about [your/(SP's)] vision and hearing.
[Do you/Does (SP)] wear eyeglasses or contact lenses?

Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... no trouble
seeing, a little trouble, a lot of trouble, or no usable vision?

[Have you/Has (SP)] been told that [you are/(SP) is] legally blind?
ECLEGBLI

HFB2A

yes/no

[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, they cannot
see well enough to drive.]
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)?

EDOCEXAM

HFB6

yes/no

INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
[IF NEEDED: Please include any eye exams that took place during a visit that you may have already told me
about.]

BOX HFC

EDOCLAST

HFB7

routing

code one

IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFB7-EDOCLAST.
ELSE GO TO BOX HFB1.

How long has it been since [your/(SP's)] last eye examination by an eye doctor?

I have a couple of questions about [your/(SP’s)] last eye examination.

EDOCTYPE

HFB7A

code one

Was the eye examination given by an optometrist, ophthalmologist or some other type of doctor or eye care
professional?
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who diagnoses and treats visual
health problems. An ophthalmologist is a doctor of medicine (M.D.) who specializes in surgery and diseases of
the eye.]

EDOCTYOS

HFB7A

verbatim text

OTHER (SPECIFY)

H7B7B - EDOCDLAT

Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in [your/(SP)’s] eyes?
EDOCDLAT

HFB7B

yes/no

(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops often (-8) DON'T KNOW
make your eyes more sensitive to bright light and may cause temporary blurry vision.]
(-9) REFUSED

BOX HFB7

routing

IF P_CATAREVR^=YES, GO TO CATAREVR,
ELSE GO TO BOX HFB7A.

BOX HFB7

Page 2 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/(SP)] had any of these conditions.

CATAREVR

HFB7C

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…
Cataracts?

BOX HFB7A

routing

HFB7C

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…]
Glaucoma?

BOX HFB7B

routing

HFB7C

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…]
Diabetic retinopathy?

BOX HFB7C

routing

HFB7C

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…]
Macular degeneration or age-related macular degeneration, also called AMD?

BOX HFB1A

CATAROP

routing

HFB10

yes/no

[Have you/Has (SP)] ever had an operation for cataracts?

BOX HFB1

routing

IF [HFB7C - RETINEVR = 1/Yes OR HFB7C - MACULEVR = 1/Yes] AND P_EYESURG^=YES, GO TO HFB11 EYESURG.
ELSE GO TO HFC1 - HCHELP.

HFB11

yes/no

[Have you/Has (SP)] ever had laser surgery to the back of either eye for one of these conditions?
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the front of the eye used to correct vision.]

HCHELP

HCTROUB

HCKNOWMC

HFC1

HFC2

HFC3

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

BOX HFB7B

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

BOX HFB7C

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

BOX HFB1A

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

BOX HFB1

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

HFC1 - HCHELP

(01) YES
(02) NO
(03) SP IS DEAF
(-8) DON'T KNOW
(-9) REFUSED

(01) HFC2 - HCTROUB
(02) HFC2 - HCTROUB
(03) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL

IF CATAREVR=02/NO or P_CATAROP=YES, GO TO BOX HFB1.
ELSE GO TO HFB10 - CATAROP.

Laser surgery to the back of the eye, or retina, is a commonly used treatment for diabetic retinopathy and
macular degeneration.
EYESURG

BOX HFB7A

IF P_MACULEVR^=YES, GO TO MACULEVR,
ELSE GO TO BOX HFB1A.
[I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/(SP)] had any of these conditions.

MACULEVR

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

IF P_RETINEVR^=YES, GO TO RETINEVR,
ELSE GO TO BOX HFB7C.
[I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/(SP)] had any of these conditions.

RETINEVR

Routing

IF P_GLCOMEVR^=YES, GO TO GLCOMEVR,
ELSE GO TO BOX HFB7B.
[I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/(SP)] had any of these conditions.

GLCOMEVR

Code List

yes/no

[Do you/Does (SP)] use a hearing aid?

code one

(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a little trouble, a lot (03) A LOT OF TROUBLE HEARING
of trouble, or deaf?
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED

code one

How much trouble [do you/does (SP)] have finding out things [you need/(SP) needs] to know about Medicare
because [of (your/(SP's)) difficulty hearing [with a hearing aid]/(you are/(SP) is) deaf]? Would you say [you
have/(SP) has] no trouble, a little trouble, or a lot of trouble?

(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED

(01) HFD1A - FOODTRBL
(02) HFC3 - HCKNOWMC
(03) HFC3 - HCKNOWMC
(04) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL

HFC4 - HCCOMDOC

Page 3 of 38

2025 MCBS Community Questionnaire

Variable Name

HCCOMDOC

FOODTRBL

MR Screen Name

HFC4

HFD1A

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

code one

How much trouble [do you/does (SP)] have communicating with [your/(SP's)] doctor or other health professional
because [of (your/(SP's)) difficulty hearing [with a hearing aid]/(you are/(SP) is) deaf]? Would you say [you
have/(SP) has] no trouble, a little trouble, or a lot of trouble?

(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED

HFD1A - FOODTRBL

How much trouble [do you/does (SP)] have eating solid foods because of problems with [your/(SP)'s] mouth or
teeth? Would you say [you have/(SP) has] no trouble, a little trouble, or a lot of trouble?

(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED

DRYMOUTH-DRYMOUTH

(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(-8) DON'T KNOW
(-9) REFUSED

TOOTHSEN-TOOTHSEN

(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(06) NOT APPLICABLE
(-8) DON'T KNOW
(-9) REFUSED

ORALPAIN-ORALPAIN

01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

CHEWPROB-CHEWPROB

01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

ORALLOOK-ORALLOOK

01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

JOBTEETH-JOBTEETH

01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

LESSFLAV-LESSFLAV

01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

HFE1-HEIGHTFT

How tall [are you/is (SP)]?

(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED

HFE1 - HEIGHTIN

How tall [are you/is (SP)]?

(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED

HFE1 - WEIGHT

code one

SHOW CARD HF3
DRYMOUTH

DRYMOUTH

code one

Since (LAST HF MONTH YEAR), how often [have you/ has (SP)] experienced any of the following problems?
Dry mouth?

SHOW CARD HF3
TOOTHSEN

TOOTHSEN

code one

[Since (LAST HF MONTH YEAR), how often [have you/ has (SP)] experienced any of the following problems?]
Tooth sensitivity to hot or cold food or drinks?
IF THE RESPONDENT HAS LOST ALL OF THEIR NATURAL TEETH, SELECT 'NOT APPLICAPLE'

ORALPAIN

ORALPAIN

code one

SHOW CARD HF4
Since [LAST HF MONTH YEAR], [have you/has (SP)] had painful aching in [your/their] mouth? Would you say:

SHOW CARD HF4
CHEWPROB

CHEWPROB

code one

Since [LAST HF MONTH YEAR], [have you/has(SP)] had difficulty chewing any foods because of problems, if
any, with [your/their] teeth, mouth, dentures, or jaw? Would you say:

SHOW CARD HF4
ORALLOOK

ORALLOOK

code one

Since [LAST HF MONTH YEAR], [have you/has (SP)] felt uncomfortable about the appearance of [your/their]
teeth, mouth, dentures, or jaws? Would you say:
[IF NEEDED: “Uncomfortable” can include a wide spectrum of emotions (embarrassment, anxiety, anger,
sadness, etc.).]
SHOW CARD HF4

JOBTEETH

JOBTEETH

code one

Since [LAST HF MONTH YEAR], [have you/has (SP)] had difficulty doing [your/their] usual activities because of
problems, if any, with [your/their] teeth, mouth, dentures, or jaws? Would you say:
[IF NEEDED: “Activities” may include going to a job, doing housework such as light cleaning, shopping, or
running errands, preparing meals, etc.]

SHOW CARD HF4
LESSFLAV

HEIGHTFT

HEIGHTIN

LESSFLAV

HFE1

HFE1

code one

numeric

numeric

Since [LAST HF MONTH YEAR], [have you/has (SP)] felt that there has been less flavor in [your/their] food
because of problems, if any, with [your/their] teeth, mouth, dentures, or jaws? Would you say:

Page 4 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

WEIGHT

HFE1

numeric

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

How much [do you/does (SP)] weigh?

(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED

LOSTWGHT

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

EATLESWK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFHINTRO - DIFINTRO

(01) CONTINUE
(-7) Empty

HFH1 - DIFSTOOP

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

HFH2 - DIFLIFT

[WEIGHT SHOULD BE RECORDED IN POUNDS]
[Have you/Has (SP)] lost weight in the past 6 months without trying to lose this weight?

LOSTWGHT

LOSTWGHT

yes/no

IF RESPONDENT REPORTS A WEIGHT LOSS BUT THE WEIGHT WAS GAINED BACK, CONSIDER IT AS
NO WEIGHT LOSS.
[IF NEEDED: Is [your/(SP)'s] clothing fitting more loosely?]
[Have you/Has (SP)] been eating less than usual for more than a week?

EATLESWK

EATLESWK

yes/no

DIFINTRO

HFHINTRO

no entry

IF THE RESPONDENT REPORTS THAT THEY HAVE INTENTIONALLY BEEN EATING LESS (DIETING,
FASTING, ETC.) SELECT "YES" AT THIS SCREEN
Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of activities. Please
tell me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of
difficulty, or [is/are] not able to do it.

SHOW CARD HF5
DIFSTOOP

HFH1

code 1

How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would you say [you
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do it?

SHOW CARD HF5

DIFLIFT

HFH2

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10 pounds, like a
(03) SOME DIFFICULTY
heavy bag of groceries?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, (-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

HFH3 - DIFREACH

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about reaching or extending arms above shoulder level?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty,
(-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

HFH4 - DIFWRITE

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty,
(-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

HFH5 - DIFWALK

code 1

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty,
(-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

HFH10INT - PHYSACTINTRO

no entry

We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large
increases in breathing or heart rate. Moderate activities cause small increases in breathing or heart rate. First I
will ask about the vigorous activities that [you do/(SP) does].

(01) CONTINUE
(-7) Empty

HFH10 - VIGUNIT

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

(01) HFH10 - VIGNUM
(02) HFH10 - VIGNUM
(03) HFH10 - VIGNUM
(04) HFH10 - VIGNUM
(96) HFH11 - MODUNIT
(-8) HFH11 - MODUNIT
(-9) HFH11 - MODUNIT

code 1

SHOW CARD HF5
DIFREACH

HFH3

code 1

SHOW CARD HF5
DIFWRITE

HFH4

code 1

SHOW CARD HF5
DIFWALK

HFH5

PHYSACTINTRO HFH10INT

VIGUNIT

HFH10

quantity unit

In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart
rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

Page 5 of 38

2025 MCBS Community Questionnaire

Variable Name

VIGNUM

MR Screen Name

HFH10

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

quantity unit

In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart
rate?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFH11 - MODUNIT

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

(01) HFH11 - MODNUM
(02) HFH11 - MODNUM
(03) HFH11 - MODNUM
(04) HFH11 - MODNUM
(96) HFH12 - MUSUNIT
(-8) HFH12 - MUSUNIT
(-9) HFH12 - MUSUNIT

(01) continous answer

(01) HFH12 - MUSUNIT

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

(01) HFH12 - MUSNUM
(02) HFH12 - MUSNUM
(03) HFH12 - MUSNUM
(04) HFH12 - MUSNUM
(96) HFJINTRO - MEDCONDINTRO
(-8) HFJINTRO - MEDCONDINTRO
(-9) HFJINTRO - MEDCONDINTRO

In a typical week, how much time [do you/does (SP)] spend doing exercises to increase [your/(SP)'s] muscle
strength or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?

(01) Continunous answer

HFJINTRO - MEDCONDINTRO

(01) CONTINUE
(-7) Empty

BOX HFJ1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ2 - OCHBP

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ2
(02) HFJ4 - OCMYOCAR
(-8) HFJ4 - OCMYOCAR
(-9) HFJ4 - OCMYOCAR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ4 - OCMYOCAR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ3
(02) HFJ6 - OCCHD
(-8) HFJ6 - OCCHD
(-9) HFJ6 - OCCHD

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ6 - OCCHD

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

MODUNIT

HFH11

quantity unit

In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

MODNUM

HFH11

numeric

In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
Now I’m going to ask you about activities [you/(SP)] may do to increase [your/(SP)'s] muscle strength or
flexibility.

MUSUNIT

MUSNUM

HFH12

HFH12

quantity unit

numeric

In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength or
flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

MEDCONDINTRO HFJINTRO

BOX HFJ1

OCARTERY

HFJ1

no entry

routing

yes/no

Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH YEAR) has/Has] a doctor or other
health professional [ever] told [you/(SP)] that [you/(SP)] had any of these conditions?
[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE SP HAS THE CONDITION.]
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS ROUND
(sample_person.P_OCARTERY=1), GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...
hardening of the arteries or arteriosclerosis?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] [still has/still have/had/has/have...]

OCHBP

HFJ2

yes/no

hypertension, sometimes called high blood pressure?
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]

BOX HFJ2

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] still had
hypertension or high blood pressure?

YRHBP

OCMYOCAR

HFJ3

HFJ4

yes/no

yes/no

[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
a myocardial infarction or heart attack?

BOX HFJ3

YRMYOCAR

HFJ5

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had a
myocardial infarction or heart attack?

Page 6 of 38

2025 MCBS Community Questionnaire

Variable Name
OCCHD

MR Screen Name
HFJ6

Question Type
yes/no

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ4
(02) HFJ8 - OCCFAIL
(-8) HFJ8 - OCCFAIL
(-9) HFJ8 - OCCFAIL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ8 - OCCFAIL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ5
(02) HFJ14 - OCHRTCND
(-8) HFJ14 - OCHRTCND
(-9) HFJ14 - OCHRTCND

[a new episode of] angina pectoris or coronary heart disease?
BOX HFJ4

YRCHD

OCCFAIL

HFJ7

HFJ8

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had an
episode of angina pectoris or coronary heart disease?

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
[a new episode of] congestive heart failure?

BOX HFJ5

YRCFAIL

HFJ9

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ14 - OCHRTCND.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had an
episode of congestive heart failure?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ14 - OCHRTCND

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
OCHRTCND

HFJ14

yes/no

(01) YES
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with the
(-9) Refused
rhythm of the heartbeat, such as atrial fibrillation.]
[a new episode of] any other heart condition?

(01) BOX HFJ8
(02) HFJ16 - OCSTROKE
(-8) HFJ16 - OCSTROKE
(-9) HFJ16 - OCSTROKE

[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]
BOX HFJ8

YRHRTCND

HFJ15

routing

yes/no

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YRHRTCND.
ELSE GO TO HFJ16 - OCSTROKE.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had an
episode of any other heart condition?

(01) YES
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with the
(-9) Refused
rhythm of the heartbeat, such as atrial fibrillation.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

OCSTROKE

HFJ16

yes/no

a stroke, a brain hemorrhage, or a cerebrovascular accident?
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]

BOX HFJ9

YRSTROKE

HFJ17

routing

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had a
stroke, a brain hemorrhage, or a cerebrovascular accident?

Has a doctor or other health professional ever told [you/(SP)] that [you/(SP)] had high cholesterol?

YRCLSTRL

HFJ17A

HFJ17B

yes/no

yes/no

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ9

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ17A - OCCLSTRL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFJ17B - YRCLSTRL
(2) BOX HFJ29
(-8) BOX HFJ29
(-9) BOX HFJ29

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3] AND OCSTROKE=01/YES , GO TO HFJ17 YRSTROKE.
ELSE, IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17A - OCCLSTRL.
ELSE GO TO HFJ17B - YRCLSTRL.

[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]

OCCLSTRL

HFJ16 - OCSTROKE

[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had high
cholesterol?
(01) YES
(02) NO
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
(-8) Don't Know
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
(-9) Refused
CONDITION.]

BOX HFJ29

Page 7 of 38

2025 MCBS Community Questionnaire

Variable Name

BLOSWGHT

CLOSWGHT

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ45-BLOSWGHT.
ELSE IF be P_EVRLWGHT ^= YES THEN GO TO HFJ46-CLOSWGHT.
ELSE GO TO HFJ18 - OCCSKIN.

HFJ45

yes/no

To lower risk for certain diseases, [have you/has (SP)] ever been told by a doctor or health professional to
control weight or lose weight?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ18 - OCCSKIN

yes/no

To lower risk for certain diseases, since (SAMPLE_PERSON.DATE_FALLRND) [have you/has (SP)] been told
by a doctor or health professional to control weight or lose weight?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ18 - OCCSKIN

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ10
(02) HFJ20 - EVRCANCR
(-8) HFJ20 - EVRCANCR
(-9) HFJ20 - EVRCANCR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ20 - EVRCANCR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ11
(02) BOX HFJ13
(-8) BOX HFJ13
(-9) BOX HFJ13

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ22 - EVRCODE

(06) BLADDER
(16) BLOOD
(17) BONE
(10) BRAIN
(03) BREAST
(09) CERVIX
(02) COLON (BOWEL)
(18) ESOPHAGUS
(19) GALL BLADDER
(11) KIDNEY
(20) LARYNX (WINDPIPE)
(21) LEUKOCYTES (LEUKEMIA)
(22) LIVER
(01) LUNG
(23) LYMPH NODES (LYMPHOMA)
(24) MOUTH/TONGUE/LIP
(07) OVARY
(25) PANCREAS
(05) PROSTATE
(26) RECTUM
(27) SOFT TISSUE/FAT
(08) STOMACH
(28) TESTIS
(12) THROAT
(29) THYROID
(04) UTERUS
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) BOX HFJ13
(02) BOX HFJ13
(03) BOX HFJ13
(04) BOX HFJ13
(05) BOX HFJ13
(06) BOX HFJ13
(07) BOX HFJ13
(08) BOX HFJ13
(09) BOX HFJ13
(10) BOX HFJ13
(11) BOX HFJ13
(12) BOX HFJ13
(16) BOX HFJ13
(17) BOX HFJ13
(18) BOX HFJ13
(19) BOX HFJ13
(20) BOX HFJ13
(21) BOX HFJ13
(22) BOX HFJ13
(23) BOX HFJ13
(24) BOX HFJ13
(25) BOX HFJ13
(26) BOX HFJ13
(27) BOX HFJ13
(28) BOX HFJ13
(29) BOX HFJ13
(91) HFJ22 -EVROS
(-8) BOX HFJ13
(-9) BOX HFJ13

(01) [Continuous answer.]

BOX HFJ13

HFJ46

HFJ18

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
[a new occurrence of] skin cancer?

BOX HFJ10

YRCSKIN

HFJ19

routing

yes/no

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 -EVRCANCR.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had an
occurrence of skin cancer?
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or cancer of the
[READ RESPONSES BELOW].]

EVRCANCR

Routing

BOX HFJ29

[I've recorded that [you/(SP)] previously reported having had skin cancer.]
OCCSKIN

Code List

HFJ20

yes/no

[Since (LAST HF MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had any [other] kind of cancer, malignancy, or tumor other than skin cancer?
DO NOT INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.

BOX HFJ11

YRCANCER

HFJ21

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - EVRCODE.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had any
kind of cancer, malignancy, or tumor other than skin cancer?

SHOW CARD HF6

EVRCODE

HFJ22

code all

[Since the first time a doctor or other health professional told [you/(SP)] that [you/(SP)] had a cancer,
malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the cancer or tumor other than skin
cancer found?
[PROBE: Any other part?]
CHECK ALL THAT APPLY

EVROS

HFJ22

verbatim text

Specify the part of parts of your body where the cancer or tumor was found.

Page 8 of 38

2025 MCBS Community Questionnaire

Variable Name

OCARTHRH

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFJ13

routing

IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCARTHRH=1), GO TO BOX HFJ13B.
ELSE GO TO HFJ24 - OCARTHRH.

HFJ24

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
rheumatoid arthritis?

BOX HFJ13B

OCOSARTH

HFJ24B

routing

yes/no

OCARTH

HFJ25

routing

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

YRARTHRD

routing

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(you/(SP)) had...]

HFJ26

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had
arthritis, other than rheumatoid or osteoarthritis, in any part of [your/(SP's)] body?

BOX HFJ16

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.

HFJ28

yes/no

an intellectual disability?
[EXPLAIN IF NECESSARY:] This is also known as intellectual development disorder or a general learning
disability. It was formerly known as mental retardation.

BOX HFJ16A

OCALZMER

HFJ29A

routing

yes/no

OCDEMENT

HFJ29B

routing

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

BASKDEPRS

CASKDEPRS

HFJ47

HFJ48

BOX HFJ14

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ15
(02) BOX HFJ16
(-8) BOX HFJ16
(-9) BOX HFJ16

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ16

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ16A

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ16B
(02) BOX HFJ16B
(-8) BOX HFJ16B
(-9) BOX HFJ16B

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ30

IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND
(sample_person.P_OCDEMENT=1), GO TO BOX HFJ30
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
any type of dementia other than Alzheimer's disease?

BOX HFJ30

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCALZMER=1), GO TO BOX HFJ16B.
ELSE GO TO HFJ29A - OCALZMER.

Alzheimer's disease?
BOX HFJ16B

BOX HFJ13B

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.

[Has a doctor or other health professional ever told [you/(SP)] that [you/(SP)] had...]
OCMENTAL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND [sample_person.P_OCARTH=1], GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.

arthritis, other than rheumatoid or osteoarthritis?
BOX HFJ15

Routing

IF SP HAS EVER REPORTED HAVING OSTEOARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCOSARTH=1), GO TO BOX HFJ14.
ELSE GO TO HFJ24B-OCOSARTH.

osteoarthritis?
BOX HFJ14

Code List

routing

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ47-BASKDEPRS.
ELSE IF P_EVRDPRSS ^= YES THEN GO TO HFJ48-CASKDEPRS.
ELSE GO TO HFJ30AA - OCDEPRSS.

yes/no

(01) YES
Has a doctor or other health professional ever asked [you/(SP)] if there was a period of time when [you/(SP)] felt (02) NO
sad, empty, or depressed?
(-8) Don't Know
(-9) Refused

HFJ30AA - OCDEPRSS

yes/no

(01) YES
Since (SAMPLE_PERSON.DATE_FALLRND), has a doctor or other health professional asked [you/(SP)] if there (02) NO
was a period of time when [you/(SP)] felt sad, empty, or depressed?
(-8) Don't Know
(-9) Refused

HFJ30AA - OCDEPRSS

Page 9 of 38

2025 MCBS Community Questionnaire

Variable Name
OCDEPRSS

MR Screen Name
HFJ30AA

Question Type
yes/no

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ17A
(02) HFJ30A - OCPSYCHO
(-8) HFJ30A - OCPSYCHO
(-9) HFJ30A - OCPSYCHO

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ30A - OCPSYCHO

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ17B
(02) BOX HFJ19
(-8) BOX HFJ19
(-9) BOX HFJ19

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ19

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ33 - OCBRKHIP

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ20
(02) BOX HFJ21
(-8) BOX HFJ21
(-9) BOX HFJ21

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ21

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ22

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ37 - OCPPARAL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ23
(02) BOX HFJ24
(-8) BOX HFJ24
(-9) BOX HFJ24

depression?
BOX HFJ17A

YRDEPRSS

HFJ30BB

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had
depression?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

OCPSYCHO

HFJ30A

yes/no

a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]

BOX HFJ17B

YRPSYCHO

HFJ31A

routing

yes/no

IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had a
mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]

BOX HFJ19

OCOSTEOP

HFJ32

routing

yes/no

IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND
(sample_person.P_OCOSTEOP=1), GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
osteoporosis, sometimes called fragile or soft bones?

OCBRKHIP

HFJ33

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]]
a broken hip?

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.

HFJ34

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had a
broken hip?

BOX HFJ21

routing

IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.

BOX HFJ20

YRBRKHIP

OCPARKIN

HFJ35

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
Parkinson's disease?

BOX HFJ22

routing

IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]

OCEMPHYS

HFJ36

yes/no

emphysema, asthma, or COPD?
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE

OCPPARAL

HFJ37

yes/no

IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/(SP)] had...]
complete or partial paralysis?

Page 10 of 38

2025 MCBS Community Questionnaire

Variable Name

YRPPARAL

OCAMPUTE

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFJ23

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.

HFJ38

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had
complete or partial paralysis?

BOX HFJ24

routing

IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS ROUND
(sample_person.P_OCAMPUTE=1), GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.

HFJ39

yes/no

IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT ASK. OTHERWISE,
ASK:
What about absence or loss of an arm or a leg?

BOX HFJ25

HAVEPROS

HFJ40

routing

yes/no

YRPROST

OCKIDNY

YRKID

OCBETES

YRBETES

routing

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ24

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ25

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) Don't Know
(-9) Refused

(01) BOX HFJ26
(02) BOX HFCI
(03) BOX HFCI
(-8) BOX HFCI
(-9) BOX HFCI

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) Don't Know
(-9) Refused

BOX HFCI

IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO BOX HFCI.
ELSE GO TO HFJ40 - HAVEPROS.
[[Before (you/[SP]) had prostate surgery, did a doctor or other health professional ever tell/Since (LAST HF
MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that [you/(SP)] had...]
an enlarged prostate or benign prostatic hypertrophy (BPH)?

BOX HFJ26

Code List

IF SP IS IN THE BASELINE SAMPLE (sample_person.INTTYPE=3), GO TO HFJ41 - YRPROST.
ELSE GO TO BOX HFCI.

HFJ41

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/(SP)] had an
enlarged prostate or benign prostatic hypertrophy (BPH)?

BOX HFCI

routing

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP16A-OCKIDNY.
ELSE IF P_DKIDNY ^= YES, GO TO YRKID-YRKID.
ELSE GO TO HFCA.

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/(SP) has] chronic
kidney disease?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

YRKID

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [Have you/Has (SP)] been told by a doctor or other health
professional that [you have/(SP) has] chronic kidney disease?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCA

routing

IF P_OCBETES=YES AND P_DIAPRGNT^=1, GO TO BOX HFCB.
ELSE IF SP IS IN THE BASELINE SAMPLE (sample_person.INTTYPE=3), GO TO HFJ41A-OCBETES.
ELSE GO TO YRBETES-YRBETES.

yes/no

Has a doctor or other health professional ever told [you/(SP)] that [you/(SP)] had any type of diabetes, including: (01) YES
(02) NO
sugar diabetes, high blood sugar, [borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
(-8) Don't Know
diabetes, or pre-diabetes]?
(-9) Refused

HFP16A

HFJ41A

YRBETES

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], has a doctor or other health professional told [you/(SP)] that
[you/(SP)] had any type of diabetes, including:
sugar diabetes, high blood sugar, [borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes]?

BOX HFCA

BOX HFCA

(01) HFJ41B - OCDTYPE
(02) AUTOIMRX-AUTOIMRX
(-8) AUTOIMRX-AUTOIMRX
(-9) AUTOIMRX-AUTOIMRX

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFJ41B - OCDTYPE
(02) AUTOIMRX-AUTOIMRX
(-8) AUTOIMRX-AUTOIMRX
(-9) AUTOIMRX-AUTOIMRX

(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
(04) PRE-DIABETES
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
(-8) Don't Know
(-9) Refused

(01) BOX HFCB
(02) BOX HFCB
(03) BOX HFCB
(04) BOX HFCB
(05) BOX HFCB
(91) HFJ41B - OCDTYPOS
(-8) BOX HFCB
(-9) BOX HFCB

SHOW CARD HF7
Looking at this card, please tell me which type of diabetes the doctor or other health professional said that [you
have/(SP) has].
OCDTYPE

HFJ41B

code 1

[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes. This
type of diabetes usually develops during childhood or adolescence; but, it also can develop in adults.
“Type 2” was formerly called “non-insulin dependent” or “adult-onset” diabetes. Until recently, this type of
diabetes was found only in adults; but, now it is also occurring in children.]

Page 11 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(01) [Continuous answer.]

BOX HFCB

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

AUTOIMRX-AUTOIMRX

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

WEAKIMM-WEAKIMM

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

BOX HFJ27

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ28
(02) HFJ43 - EMCAUSEVB
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO

(01) [Continuous answer.]

HFPINTRO - HLTHCAREINTRO

(01) ARTERIES HARDENING
(02) HYPERTENSION
(03) HEART ATTACK
(04) HEART DISEASE
(05) CONGESTIVE HEART FAILURE
(08) OTHER HEART PROBLEM
(09) STROKE OR HEMORRHAGE
(10) SKIN CANCER
(11) CANCER/TUMOR
(12) RHEUMATOID ARTHRITIS
(26) OSTEOARTHRITIS
(13) OTHER ARTHRITIS
(14) INTELLECTUAL DISABILITY
(15) ALZHEIMER'S
(16) DEMENTIA
(17) DEPRESSION
(18) MENTAL DISORDER
(19) OSTEOPOROSIS
(20) BROKEN HIP
(21) PARKINSON'S
(22) EMPHYSEMA/ASTHMA/COPD
(23) PARALYSIS
(24) LOSS OF LIMB
(25) DIABETES
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) HFPINTRO - HLTHCAREINTRO
(02) HFPINTRO - HLTHCAREINTRO
(03) HFPINTRO - HLTHCAREINTRO
(04) HFPINTRO - HLTHCAREINTRO
(05) HFPINTRO - HLTHCAREINTRO
(08) HFPINTRO - HLTHCAREINTRO
(09) HFPINTRO - HLTHCAREINTRO
(10) HFPINTRO - HLTHCAREINTRO
(11) HFPINTRO - HLTHCAREINTRO
(12) HFPINTRO - HLTHCAREINTRO
(26) HFPINTRO - HLTHCAREINTRO
(13)HFPINTRO - HLTHCAREINTRO
(14) HFPINTRO - HLTHCAREINTRO
(15) HFPINTRO - HLTHCAREINTRO
(16) HFPINTRO - HLTHCAREINTRO
(17) HFPINTRO - HLTHCAREINTRO
(18) HFPINTRO - HLTHCAREINTRO
(19) HFPINTRO - HLTHCAREINTRO
(20) HFPINTRO - HLTHCAREINTRO
(21) HFPINTRO - HLTHCAREINTRO
(22) HFPINTRO - HLTHCAREINTRO
(23) HFPINTRO - HLTHCAREINTRO
(24) HFPINTRO - HLTHCAREINTRO
(25) HFPINTRO - HLTHCAREINTRO
(91) HFJ44 - EMOS
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO

SOME OTHER TYPE (SPECIFY)
OCDTYPOS

OCDVISIT

AUTOIMRX

HFJ41B

verbatim text

BOX HFCB

routing

HFJ41C

AUTOIMRX

yes/no

yes/no

[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
IF (P_OCBETES ^= YES AND (OCBETES = YES or YRBETES = YES)) OR (P_OCBETES = YES AND
P_OCDVISIT ^= YES), GO TO HFJ41C-OCDVISIT.
ELSE GO TO AUTOIMRX-AUTOIMRX .

[Were you/Was (SP)] told on two or more different visits that [you/(SP)] had diabetes?

Since (REFERENCE DATE), [have you/has (SP)] taken prescription medication or had any medical treatments
that a doctor or other health professional told [you/(SP)] would weaken [your/(SP)] immune system?
[IF NEEDED: This question is asking about both long-term and short-term effects on the immune system.]

WEAKIMM

WEAKIMM

yes/no

[Do you/Does (SP)] currently have a health condition that a doctor or other health professional told [you/(SP)]
weakens the immune system?
[IF NEEDED: Please include any health conditions you may have already told me about.]

BOX HFJ27

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY
WAS UNDER 65 (sample_person.INTTYPE=3 and AGECALC<65 and greater than 0) THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 - EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 - EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF CURRENT MEDICARE
ELIGIBILITY WAS NOT UNDER 65 THEN GO TO HFPINTRO - HLTHCAREINTRO.
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW]. [Was this/Were any of these]
the original cause of [your/(SP's)] becoming eligible for Medicare?

EMCOND

HFJ42

yes/no

[LIST ALL CONDITIONS WHERE "YES" ANSWER RECORDED AT HFJ1 THROUGH HFJ41C]
[NOTE THAT CONDITIONS MAY NOT BE DISPLAYED WITH THE EXACT CONDITION NAME THAT WAS
USED EARLIER IN THE INTERVIEW (E.G., HYPERTENSION CAN ALSO BE CALLED HIGH BLOOD
PRESSURE AT DIFFERENT QUESTIONS).]

EMCAUSEVB

HFJ43

verbatim text

What was the original cause of [your/(SP's)] becoming eligible for Medicare?
RECORD VERBATIM.

BOX HFJ28

routing

IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO HFPINTRO - HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.

Which of these conditions was the cause of [your/(SP's)] becoming eligible for Medicare?
EMCODE

HFJ44

code all

[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.

Page 12 of 38

2025 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

EMOS

HFJ44

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer.]

HFPINTRO - HLTHCAREINTRO

HLTHCAREINTR
O

HFPINTRO

no entry

Now I want to ask you about some things that [you/(SP)] may be doing to maintain [your/(SP)'s] health, either by
getting tested for health problems or by taking care of conditions that [you have/(SP) has].

(01) CONTINUE
(-7) Empty

BOX HFP1A

routing

IF SP IS IN THE BASELINE SAMPLE AND OCBETES=1/Yes AND HFJ41B - OCDTYPE ^= 5/GESTATIONAL),
GO TO HFP1 - DIAAGE,
ELSE IF YRBETES=1/Yes AND HFJ41B - OCDTYPE ^= 5/GESTATIONAL), GO TO HFP1 - DIAAGE,
ELSE IF P_OCBETES=1/YES AND P_DIAPRGNT^=1 AND P_DIAINSUL=1/YES, GO TO INSUTRBL,
ELSE IF P_OCBETES = 1/YES AND P_DIAPRGNT^=1, GO TO HFP14A-DIAFEET,
ELSE GO TO BOX HFC2.

HFP1

numeric

I recorded that [you were/(SP) was] told by a doctor or other health professional that [you have/(SP) has] [Type 1 (01) [Continuous answer.]
diabetes/Type 2 diabetes/borderline diabetes/pre-diabetes/diabetes].
(-7) Empty
(-8) Don't Know
How old [were you/was (SP)] when [you were/(SP) was] first told that [you/(SP)] had diabetes?
(-9) Refused

BOX HFP2

routing

IF THE SP IS FEMALE (ROSTSEX=2) AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR (HFP1 – DIAAGE = DK
OR RF), GO TO HFP2 - DIAPRGNT.
ELSE GO TO HFP4 - DIAINSUL.

BOX HFP1A

DIAAGE

DIAPRGNT

DIAINSUL

HFP2

HFP4

yes/no

list

Did [you/(SP)] have diabetes only during a pregnancy?

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/(SP)'s] diabetes. [Do
you/Does (SP)]…
take insulin?

DIAMEDS

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/(SP)'s] diabetes. [Do
you/Does (SP)]…
take prescription diabetes pills or oral diabetes medicine?

DIATEST

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/(SP)'s] diabetes. [Do
you/Does (SP)]…
test [your/(SP)'s] blood for sugar or glucose?

DIASORES

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/(SP)'s] diabetes. [Do
you/Does (SP)]…
check for sores or irritations on [your/(SP)'s] feet?

DIAPRESS

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/(SP)'s] diabetes. [Do
you/Does (SP)]…
measure [your/(SP)'s] blood pressure at home?

DIAASPRN

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/(SP)'s] diabetes. [Do
you/Does (SP)]…
take aspirin regularly for [your/(SP)'s] diabetes?

BOX HFP3

INSUTRBL

INSUMODE

INSUTRBL

INSUMODE

routing

IF HFP4 - DIAINSUL = 1/Yes, GO TO INSUTRBL-INSUTRBL.
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKN.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

yes/no

Since (LAST HF MONTH YEAR), [have you/has (SP)] had any problems paying or were unable to pay for
insulin?

select all

[Do you/does (SP)] administer [your/their] insulin with…
a syringe, insulin pen, insulin pump, and/or inhaler?

BOX HFP2

(01) YES
(02) NO
(03) QUESTION DOES NOT APPLY TO SP
(-8) Don't Know
(-9) Refused

(01) BOX HFC2
(02) HFP4 - DIAINSUL
(03) BOX HFC2
(-8) BOX HFC2
(-9) BOX HFC2

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP4 - DIAMEDS

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP4 - DIATEST

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP4 - DIASORES

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP4 - DIAPRESS

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP4 - DIAASPRN

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFP3

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

INSUMODE

(01) SYRINGE
(02) INSULIN PEN
(03) INSULIN PUMP
(04) INHALER
(-8) Don't Know
(-9) Refuse

BOX HFDB

Page 13 of 38

2025 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFDB

routing

IF P_OCBETES=1/YES, GO TO HFP14A-DIAFEET,
ELSE IF INSUMODE INCLUDES 03/INSULIN PUMP, GO TO BOX HFP4,
ELSE GO TO INSUOFTN.

Code List

Routing

(01) HFP5 - INSUOFDY
(02) HFP5 - INSUOFWK
(-8) BOX HFP4
(-9) BOX HFP4

INSUOFTN

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(-8) Don't Know
(-9) Refused

INSUOFDY

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

(01) [Continuous answer.]

BOX HFP4

INSUOFWK

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

(01) [Continuous answer.]

BOX HFP4

routing

IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKN.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) HFP6 - MEDDAY
(02) HFP6 - MEDWEEK
(03) ) HFP6 - MEDMONTH
(-8) BOX HFP5
(-9) BOX HFP5

BOX HFP4

MEDSTAKE

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused

MEDDAY

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) [Continuous answer.]

BOX HFP5

MEDWEEK

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) [Continuous answer.]

BOX HFP5

MEDMONTH

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) [Continuous answer.]

BOX HFP5

BOX HFP5

routing

IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKN.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

(01) [Continuous answer.]
[996] RESPONDENT USES A CONTINUOUS
GLUCOSE MONITORING SYSTEM
(-8) Don't Know
(-9) Refused

HFP7- TESTTAKE

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused

BOX HFP6

How often [do you/does (SP)] test [your/(SP)'s] blood for sugar or glucose?

TESTTAKN

HFP7

numeric

[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested
by a health professional.]
[ENTER QUANTITY AND UNIT.]
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH
QUANTITY AND UNIT OF GLUCOSE TESTS.]
How often [do you/does (SP)] test [your/(SP)'s] blood for sugar or glucose?

TESTTAKE

HFP7

quantity unit

[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested
by a health professional.]
[ENTER QUANTITY AND UNIT.]
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH
QUANTITY AND UNIT OF GLUCOSE TESTS.]

BOX HFP6

routing

IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
[PROBE: Include times when they are checked by a family member or friend, but do not include times when they (04) NUMBER OF TIMES PER YEAR
are checked by a health professional.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] check [your/(SP)'s] feet for sores or irritations?

SORECHEK

HFP8

quantity unit

(01) HFP8 - SOREDAY
(02) HFP8 - SOREWEEK
(03) HFP8 - SOREMNTH
(04) HFP8 - SOREYEAR
(-8) HFP10 - DIATENYR
(-9) HFP10 - DIATENYR

How often [do you/does (SP)] check [your/(SP)'s] feet for sores or irritations?
SOREDAY

HFP8

quantity unit

[PROBE: Include times when they are checked by a family member or friend, but do not include times when they
are checked by a health professional.]

(01) [Continuous answer.]

HFP10 - DIATENYR

(01) [Continuous answer.]

HFP10 - DIATENYR

How often [do you/does (SP)] check [your/(SP)'s] feet for sores or irritations?
SOREWEEK

HFP8

quantity unit

[PROBE: Include times when they are checked by a family member or friend, but do not include times when they
are checked by a health professional.]

Page 14 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(01) [Continuous answer.]

HFP10 - DIATENYR

(01) [Continuous answer.]

HFP10 - DIATENYR

HFP11 - DIADRSAW

How often [do you/does (SP)] check [your/(SP)'s] feet for sores or irritations?
SOREMNTH

HFP8

quantity unit

[PROBE: Include times when they are checked by a family member or friend, but do not include times when they
are checked by a health professional.]
How often [do you/does (SP)] check [your/(SP)'s] feet for sores or irritations?

SOREYEAR

HFP8

quantity unit

[PROBE: Include times when they are checked by a family member or friend, but do not include times when they
are checked by a health professional.]

DIATENYR

HFP10

yes/no

In the past year has a doctor or other health professional examined [your/(SP)'s] feet for sores or irritations?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

DIADRSAW

HFP11

numeric

About how many times in the past year [have you/has (SP)] seen a doctor or other health professional for
[your/(SP)'s] diabetes?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFP13 - DIAHEMOC

DIAHEMOC

HFP13

numeric

A test of hemoglobin "A one C" measures the average level of blood sugar over the past three months. It is
usually done in a doctor's office. About how many times in the past year has a doctor or other health
professional checked [you/(SP)] for hemoglobin "A one C"?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFP14 - DIACTRLD

code 1

(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, some of the time, (04) A LITTLE OF THE TIME
a little of the time, or none of the time? By "well controlled" we mean a recent hemoglobin "A one C" result of 7.5 (05) NONE OF THE TIME
or less or an average fasting blood test of 140 or less.
(-8) Don't Know
(-9) Refused

HFP14A1 - DIAHYPO

yes/no

(01) YES
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an insulin (02) NO
reaction?
(-8) Don't Know
(-9) Refused

(01) HFP14A2 - DIAHYPTR
(02) BOX HFCC
(-8) BOX HFCC
(-9) BOX HFCC

SHOW CARD HF8
DIACTRLD

DIAHYPO

HFP14

HFP14A1

Please think about the most serious episode of hypoglycemia that [you have/(SP) has] experienced in the past
year.
DIAHYPTR

HFP14A2

code 1

(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
(-8) Don't Know
(-9) Refused

BOX HFCC

[Have you/Has (SP)] ever had any problems with [your/(SP)'s] feet as a result of [your/(SP)'s] diabetes?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFP14A - DIAFEET
(02) HFP15 - DIAEYPRB
(-8) HFP15 - DIAEYPRB
(-9) HFP15 - DIAEYPRB

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCD

[Were you/Was (SP)] able to treat [yourself/themselves] by taking some form of sugar, did [you/(SP)] require
treatment from others, or did [you/(SP)] require treatment by a hospital?
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being treated in the emergency room or outpatient
department of a hospital, or being admitted as an inpatient.]

BOX HFCC

DIAFTEVR

DIAFEET

DIANEURO

HFP14A3

routing

yes/no

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) , GO TO HFP14A3-DIAFTEVR.
ELSE GO TO HFP14A-DIAFEET.

HFP14A

yes/no

[Do you/Does (SP)] currently have any problems with [your/(SP's)] feet as a result of [your/(SP)'s] diabetes?

BOX HFCD

routing

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIANEURO.
ELSE IF P_DNEURO ^= YES, GO TO YRDNEURO-YRDNEURO.
ELSE GO TO BOX HFCE.

HFP14B

list

People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s]
(01) YES
feet as a result of [your/(SP)'s] diabetes.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…
(-9) Refused

BOX HFCE

Neuropathy or nerve damage, which may cause pain or numbness in the feet?

Page 15 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s] feet
as a result of [your/(SP)'s] diabetes.]

YRDNEURO

YRDNEURO

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/(SP)] had…

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCE

Neuropathy or nerve damage, which may cause pain or numbness in the feet?
BOX HFCE

DIACIRCF

HFP14B

routing

list

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIACIRCF.
ELSE IF P_DCIRCF ^= YES, GO TO YRDCIRCF-YRDCIRCF.
ELSE GO TO BOX HFCF.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s]
(01) YES
feet as a result of [your/(SP)'s] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…
(-9) Refused

BOX HFCF.

Poor circulation or blood flow in the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s] feet
as a result of [your/(SP)'s] diabetes.]
YRDCIRCF

YRDCIRCF

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/(SP)] had…

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCF

Poor circulation or blood flow in the feet?
BOX HFCF

DIAULCER

HFP14B

routing

list

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIAULCER.
ELSE IF P_DULCER ^= YES, GO TO YRDULCER-YRDULCER.
ELSE GO TO BOX HFCG.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s]
(01) YES
feet as a result of [your/(SP)'s] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…
(-9) Refused

BOX HFCG

Foot ulcers?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s] feet
as a result of [your/(SP)'s] diabetes.]
YRDULCER

YRDULCER

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has (SP)] been told by a doctor or other health
professional that [you/(SP)] had…

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCG

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP15 - DIAEYPRB

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP15 - DIAEYPRB

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCH

Foot ulcers?
BOX HFCG

DIASKINC

HFP14B

routing

list

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIASKINC.
ELSE IF P_DSKINC ^= YES, GO TO YRDSKINC-YRDSKINC.
ELSE GO TO HFP15-DIAEYPRB.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s] feet
as a result of [your/(SP)'s] diabetes.]
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/(SP)] had…
Calluses, infections, or other skin changes affecting the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/(SP)] had any of the following problems with [your/(SP)'s] feet
as a result of [your/(SP)'s] diabetes.]

YRDSKINC

YRDSKINC

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/(SP)] had…
Calluses, infections, or other skin changes affecting the feet?

DIAEYPRB

HFP15

yes/no

[Do you/Does (SP)] have any problems with [your/(SP)'s] eyes as a result of [your/(SP)'s] diabetes?

BOX HFCH

routing

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP16A1-DIAKDPEV.
ELSE GO TO HFP16-DIAKDPRB.

Page 16 of 38

2025 MCBS Community Questionnaire

Variable Name

DIAKDPEV

DIAKDPRB

DIAMNGE

CDIAMNGE

DIATRAIN

DIAKNOW

DIASUPPS

MR Screen Name

HFP16A1

Question Type

yes/no

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
[Have you/Has (SP)] ever had any problems with [your/(SP)'s] kidneys as a result of [your/(SP)'s] diabetes?
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFP16 - DIAKDPRB
(02) BOX HFC1
(-8) BOX HFC1
(-9) BOX HFC1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFC1
(02) BOX HFC1
(-8) BOX HFC1
(-9) BOX HFC1

HFP16

yes/no

[Do you/Does (SP)] currently have any problems with [your/(SP)'s] kidneys as a result of [your/(SP)'s] diabetes?

BOX HFC1

routing

IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP17-DIAMNGE.
ELSE GO TO HFP17A-CDIAMNGE.

yes/no

[Have you/Has (SP)] ever participated in a diabetes self-management course or class, or received special
training on how [you/(SP)] can manage [your/(SP)'s] diabetes?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFP18 - DIATRAIN
(02) BOX HFP7
(-8) BOX HFP7
(-9) BOX HFP7

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [have you/has (SP)] participated in a diabetes self-management
course or class, or received special training on how [you/(SP)] can manage [your/(SP)'s] diabetes?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFP7

HFP18

code 1

(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
When was the most recent time that [you/(SP)] participated in a diabetes self-management course or class or
(06) 5 YEARS TO LESS THAN 6 YEARS
received special training on hhow [you/(SP)] can manage [your/(SP)'s] diabetes?
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE MOST (09) 8 YEARS TO LESS THAN 9 YEARS
RECENT TIME.]
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

BOX HFP7

routing

IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.

HFP17

CDIAMNGE

HFP19

code 1

SHOW CARD HF9
How much do you think you know about managing your diabetes? Do you know . . .

HFP20

yes/no

Before today, did you know that Medicare now helps pay the cost of diabetic testing supplies and selfmanagement education for people with diabetes?

BOX HFC2

routing

IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP21-DIAEVERT.
ELSE GO TO HFP21A-CDIAEVER.
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
have/(SP) has] diabetes.]

DIAEVERT

Code List

HFP21

yes/no

[Have you/Has (SP)] ever had a blood test to see if [you have/(SP) has] diabetes?
[IF NEEDED: This question is asking about whether [you have/(SP) has] ever had a blood test for diabetes, not
whether [you have/(SP) has] diabetes.]

BOX HFP7

(01) just about everything you need to know,
(02) most of what you need to know,
(03) some of what you need to know,
(04) a little of what you need to know, or
(05) almost none of what you need to know about
managing your diabetes?
(-8) Don't Know
(-9) Refused

HFP20 - DIASUPPS

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFR1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFP22 - DIARECNT
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8

[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
have/(SP) has] diabetes.]
CDIAEVER

HFP21A

yes/no

(01) YES
Since [SAMPLE_PERSON.DATE_FALLRND, [have you/has (SP)] had a blood test to see if [you have/(SP) has]
(02) NO
diabetes?
(-8) Don't Know
(-9) Refused

(01) HFP24 - DIARISK
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8

[IF NEEDED: This question is asking about whether [you have/(SP) has] had a blood test since
[SAMPLE_PERSON.DATE_FALLRND for diabetes, not whether [you have/(SP) has] diabetes.]

Page 17 of 38

2025 MCBS Community Questionnaire

Variable Name

DIARECNT

DIAAWARE

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(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
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

HFP24 - DIARISK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP24 - DIARISK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP25 - DIASIGNS

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFR1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFC3

HFP22

code 1

When was the most recent time [you were/(SP) was] tested for diabetes?

BOX HFP8

routing

IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.

HFP23

yes/no

Before today, were you aware that there is a blood test to determine if a person has diabetes?

Has a doctor or other health professional ever told [you/(SP)] that [you are/(SP) is] at high risk for diabetes?
DIARISK

DIASIGNS

HFP24

HFP25

yes/no

yes/no

[IF NEEDED: This question is asking about whether [you have/(SP) has] ever been told [you are/(SP) is] at risk
for diabetes, not whether [you have/(SP) has] diabetes.]
In the past year, [have you/has (SP)] received any information about the signs, symptoms, or risk factors for
diabetes?
[IF NEEDED: This question is asking about whether [you have/(SP) has] received any information on diabetes,
not whether [you have/(SP) has] diabetes.]
IF [(SP HAS REPORTED HAVING COLON, RECTAL, OR BOWEL CANCER IN THE CURRENT ROUND
(EVRCODE = 02/COLON (BOWEL) OR 26/RECTUM)) OR (IN A PREVIOUS ROUND (P_OCCCOLON=1 or
P_OCCRECT=1)], GO TO BOX HFS1.

BOX HFR1

routing

ELSE, IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER (P_COLHEAR=1), GO TO BOX
HFC3.
ELSE, GO TO HFR1-COLHEAR.

COLHEAR

COLHTEST

CCOLHTES

COLHKIT

Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.

HFR1

yes/no

BOX HFC3

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR3 - COLHTEST.
ELSE GO TO HFR3A - CCOLHTES.

yes/no

The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
(01) YES
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at the
(02) NO
patient’s home. The test is then sent to a laboratory for the results to be determined.
(-8) Don't Know
(-9) Refused
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the stool?

(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4

HFR3A

yes/no

The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at the (01) YES
patient’s home. The test is then sent to a laboratory for the results to be determined.
(02) NO
(-8) Don't Know
Since (SAMPLE_PERSON.DATE_FALLRND), Has a doctor or other health professional given [you/(SP)] a home (-9) Refused
testing kit to test for blood in the stool?

(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4

BOX HFC4

routing

IF P_COLHKIT=YES, GO TO HFR4A - COLFDOC.
ELSE GO TO HFR4-COLHKIT.

HFR3

HFR4

yes/no

Before today, had [you/SP] ever heard of colorectal or colon cancer?

Before today, [have you/has SP] ever heard of this home testing kit?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFR4A - COLFDOC

Page 18 of 38

2025 MCBS Community Questionnaire

Variable Name
COLFDOC

MR Screen Name
HFR4A

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

yes/no

Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the stool
while [you/(SP)] [were/was] at the doctor’s office?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFR7 - RECNTBST
(02) BOX HFC6
(-8) BOX HFC6
(-9) BOX HFC6

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFR7 - RECNTBST
(02) BOX HFC6
(-8) BOX HFC6
(-9) BOX HFC6

Did [you/(SP)] complete the samples and return them for [your/(SP)'s] most recent test?
COLCARD

RECNTBST

COLORECT

CORECTYP

HFR5

yes/no

HFR7

code 1

BOX HFC6

routing

COLORECT

CORECTYP

yes/no

code 1

[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects
invisible traces of blood found in the stool.]

When did [you/(SP)] have [your/(SP's)] most recent blood stool test [(using a home testing kit)/(at the doctor's
office)]?
[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects
invisible traces of blood found in the stool.]

CCORECTP

CCOLOREC

CCORECTP

yes/no

code 1

These next questions are about colorectal cancer screening. There are several different kinds of tests to check
for colon cancer.
(01) YES
Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube
(02) NO
into the rectum to look for polyps or cancer.
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever had either of these exams?
For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.

For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.

When did [you/(SP)] have [your/(SP)'s] most recent sigmoidoscopy or colonoscopy?
HFR9

code 1

BOX HFC7

routing

(01) Colonoscopy
(02) Sigmoidoscopy
(03) Both
(-8) Don't Know
(-9) Refused

These next questions are about colorectal cancer screening. There are several different kinds of tests to check
for colon cancer.
(01) YES
Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube (02) NO
into the rectum to look for polyps or cancer.
(-8) Don't Know
(-9) Refused
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had either of these exams?

Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a colonoscopy, a sigmoidoscopy, or
both?

WHENSCOP

BOX HFC6

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO COLORECT-COLORECT.
ELSE GO TO CCOLOREC-CCOLOREC.

[Have you/Has (SP)] ever had a colonoscopy, a sigmoidoscopy, or both?

CCOLOREC

(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
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

[IF NEEDED: If [you/(SP)] had both exams done, then please provide the date for the most recent exam]

(01) CORECTYP
(02) BOX HFC7
(-8) BOX HFC7
(-9) BOX HFC7

(01) HFR9 - WHENSCOP
(02) HFR9 - WHENSCOP
(03) HFR9 - WHENSCOP
(-8) BOX HFC7
(-9) BOX HFC7

(01) CCORECTP
(02) BOX HFC7
(-8) BOX HFC7
(-9) BOX HFC7

(01) Colonoscopy
(02) Sigmoidoscopy
(03) Both
(-8) Don't Know
(-9) Refused

BOX HFC7

(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
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

HFR13 - COLSCRNS

IF P_HEARSCOP=YES OR CCOLOREC=YES OR COLORECT=YES, GO TO BOX HFR2.
ELSE GO TO HFR10-HEARSIG.

Page 19 of 38

2025 MCBS Community Questionnaire

Variable Name
HEARSIG

COLDRREC

COLSCRNS

OSTINTRO

OSTEVERT

OSTHRISK

OSTFRACT

OSTTEST

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFR11 - COLDRREC
(02) BOX HFR2
(-8) BOX HFR2
(-9) BOX HFR2

Has a doctor or other health professional ever recommended that [you/(SP)] have this test?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFR13 - COLSCRNS

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFS1

HFR10

yes/no

Before today, had [you/(SP)] ever heard of a sigmoidoscopy or colonoscopy?

BOX HFR2

routing

IF HFR3 - COLHTEST = 1/Yes or HFR3A - CCOLHTES = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 COLSCRNS.
ELSE GO TO BOX HFS1.

HFR11

yes/no

HFR13

yes/no

Before today, did [you/(SP)] know that Medicare now pays the cost of screening tests for colorectal cancer?

BOX HFS1

routing

IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT ROUND OR IN A PREVIOUS
ROUND (OCOSTEOP=1 or sample_person.P_OCOSTEOP-=1 GO TO BOX HFC8.
ELSE GO TO HFSINTRO - OSTINTRO.

HFSINTRO

no entry

Now I'd like to talk about a disease called osteoporosis, which can be treated if found early. In osteoporosis, the
bones lose their calcium and become fragile and more easily broken.

(01) CONTINUE
(-7) Empty

HFS1 - OSTEVERT

yes/no

[Have you/Has (SP)] ever talked with [your/(SP)'s] doctor or other health professional about osteoporosis?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFS2 - OSTHRISK
(02) BOX HFC8
(-8) BOX HFC8
(-9) BOX HFC8

yes/no

(01) YES
(02) NO
Has a doctor or other health professional ever told [you/(SP)] that [you are/(SP) is] at high risk for osteoporosis?
(-8) Don't Know
(-9) Refused

HFS2A

yes/no

[Have you/Has (SP)] ever experienced a fracture that [your/(SP)'s] doctor or other health professional told
[you/(SP)] was related to osteoporosis?

BOX HFC8

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFS3-OSTTEST.
ELSE GO TO HFS3A-COSTTEST.

HFS1

HFS2

HFS3

yes/no

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFC8

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFS5 - OSTRECNT
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFS6 - OSTMASS
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9

Before today, had you ever heard of this test?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFS6 - OSTMASS
(02) HFAC29 - HCTROUBL
(-8) HFAC29 - HCTROUBL
(-9) HFAC29 - HCTROUBL

When was the most recent time that [you/(SP)] had a Bone Mass or Bone Density Measurement 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
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

HFS6 - OSTMASS

There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?

COSTTEST

OSTHEAR

OSTRECNT

HFS3A

yes/no

BOX HFC9

routing

HFS4

HFS5

yes/no

code 1

HFS2A - OSTFRACT

There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a Bone Mass or Bone Density
Measurement test?
IF P_OSTHEAR=YES, GO TO HFS6 - OSTMASS.
ELSE GO TO HFS4-OSTHEAR.

Page 20 of 38

2025 MCBS Community Questionnaire

Variable Name

OSTMASS

MR Screen Name

HFS6

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

yes/no

Before today, did you know that Medicare would pay for Bone Mass or Bone Density Measurement tests for
Medicare beneficiaries who are at risk for osteoporosis?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFAC29 - HCTROUBL

Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.
HCTROUBL

HFAC29

yes/no

(01) YES
(02) NO
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/(SP)] wanted (-8) Don't Know
or needed?
(-9) Refused

Why was that?

(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
(03) SERVICES/SUPPLIES NOT COVERED
(04) NEEDED TRANSPORTATION TO
DOCTOR/HOSPITAL
(05) DIFFICULTY GETTING HOME HEALTH CARE
(06) NO TREATMENT AVAILABLE/DOCTOR WON’T
TREAT
(07) WAIT TOO LONG/DOCTOR TOO BUSY
(08) OWN DOCTOR DOESN’T ACCEPT
MEDICARE/COULDN’T FIND DOCTOR WHO
ACCEPTS MEDICARE
(09) NOT ELIGIBLE FOR PUBLIC COVERAGE
(10) DIFFICULTY GETTING APPOINTMENT/ DELAYS
BECAUSE SP ON MEDICARE
(11) DOCTOR REFERRED SP TO SPECIALIST OR
OTHER DOCTOR
(12) HMO REFERRAL PROCESS (DIFFICULTY
GETTING)
(13) PROBLEMS WITH HMO DOCTORS NOT GOOD
OR AVAILABLE
(14) HMO WOULD NOT COVER OR PROVIDE
SERVICE
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) BOX HFF6
(02) BOX HFF6
(03) BOX HFF6
(04) BOX HFF6
(05) BOX HFF6
(06) BOX HFF6
(07) BOX HFF6
(08) BOX HFF6
(09) BOX HFF6
(10) BOX HFF6
(11) BOX HFF6
(12) BOX HFF6
(13) BOX HFF6
(14) BOX HFF6
(91) HFAC30A - HCTOTHOS
(-8) BOX HFF6
(-9) BOX HFF6

(01) [Continuous answer.]

BOX HFF6

HCTCODE

HFAC30A

code all

HCTOTHOS

HFAC30A

verbatim text

OTHER (SPECIFY)

BOX HFF6

routing

IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare OR
10/DifficultyGettingAppt, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.

yes/no

(01) YES
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they cannot schedule an (02) NO
appointment with [you/(SP)]?
(-8) Don't Know
(-9) Refused

CGETAPPT

HFAC30B

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

What were the reasons the doctor’s office offered as an explanation for not scheduling an appointment with
[you/(SP)]?

CGETCODE

HFAC30C

code all

CGETOTOS

CGETOTOS

verbatim text

Please specify the other reason.

BOX HFF7

routing

IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR
7/DocNotAcceptMCAR, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.

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

(01) HFAC30A - HCTCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY

(01) HFAC30C - CGETCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY

(01) DOCTOR DOES NOT ACCEPT INSURANCE
PLAN
(02) ALL OF DOCTORS APPOINTMENTS WERE FULL
(03) DOCTOR IS NOT ACCEPTING ANY NEW
PATIENTS
(04) DOCTOR IS NOT ACCEPTING NEW MEDICARE
PATIENTS
(05) DOCTORS HOURS CONFLICTED WITH
REQUIREMENTS OF SP
(06) DOCTOR DOES NOT ACCEPT MEDICAID
(07) DOCTOR DOES NOT ACCEPT MEDICARE AT
ALL
(08) DOCTOR DOES NOT ACCEPT MEDICARE
ASSIGNMENT
(09) DOCTOR FELT ANOTHER PROVIDER WOULD
BE BETTER FOR SP
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) BOX HFF7
(02) BOX HFF7
(03) BOX HFF7
(04) BOX HFF7
(05) BOX HFF7
(06) BOX HFF7
(07) BOX HFF7
(08) BOX HFF7
(09) BOX HFF7
(91) HFAC30C - CGETOTOS
(-8) BOX HFF7
(-9) BOX HFF7

(01) [Continuous answer.]

BOX HFF7

Page 21 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFAC30E - OFFEXVB
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY

OFFEXPLN

HFAC30D

yes/no

Did the doctor’s office explain why [it is difficult for Medicare patients to get an appointment/Medicare is not
accepted] at that practice?

OFFEXVB

HFAC30E

verbatim text

What was that explanation?
RECORD VERBATIM.

(01) [Continuous answer.]

HFAC31 - HCDELAY

yes/no

Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because [you were/(SP)
was] worried about the cost?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFAC32 A-PAYPROB

yes/no

Since (LAST HF MONTH YEAR) [have you/has (SP)] had problems paying or were unable to pay any medical
bills?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFAC32 - COLLAGNCY
(02) HFKINTRO - IADLINTRO
(-8) HFKINTRO - IADLINTRO
(-9) HFKINTRO - IADLINTRO

yes/no

(01) YES
Because of problems paying medical bills since (LAST HF MONTH YEAR), [have you/has (SP)] been contacted (02) NO
by a collection agency?
(-8) Don't Know
(-9) Refused

HFAC32B- PAYOVRTM
CHRTYCAR-CHRTYCAR

yes/no

[Do you /Does (SP)] currently have any medical bills that are being paid off over time?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKINTRO - IADLINTRO

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKINTRO - IADLINTRO

HCDELAY

PAYPROB

COLLAGNCY

PAYOVRTM

HFAC31

HFAC32A

HFAC32

HFAC32B

CHRTYCAR

CHRTYCAR

yes/no

Since (LAST HF MONTH YEAR) [have you/has (SP)] had any medical bills reduced through a financial
assistance program for people who have trouble paying?

IADLINTRO

HFKINTRO

no entry

Health problems can include physical, mental, emotional, or memory problems. I'd now like to ask you about how
(01) CONTINUE
health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to know
(-7) Empty
whether [you have/(SP) has] any difficulty doing each activity alone.

PRBTELE

DONTTELE

PRBLHWK

DONTLHWK

HFKA1

HFKA2

HFKB1

HFKB2

code 1

yes/no

code 1

yes/no

Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
using the telephone?
[You said that using the telephone is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
doing light housework (like washing dishes, straightening up, or light cleaning)?
[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something that
[you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

PRBHHWK

DONTHHWK

HFKC1

HFKC2

code 1

yes/no

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
doing heavy housework (like scrubbing floors or washing windows)?
[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

PRBMEAL

DONTMEAL

HFKD1

HFKD2

code 1

yes/no

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
preparing [your/(SP)'s] own meals?

[You said that preparing [your/(SP)'s] own meals is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

HFKA1 - PRBTELE

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKB1 - PRBLHWK
(02) HFKB1 - PRBLHWK
(03) HFKA2 - DONTTELE
(-8) HFKB1 - PRBLHWK
(-9) HFKB1 - PRBLHWK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKB1 - PRBLHWK

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKC1 - PRBHHWK
(02) HFKC1 - PRBHHWK
(03) HFKB2 - DONTLHWK
(-8) HFKC1 - PRBHHWK
(-9) HFKC1 - PRBHHWK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKC1 - PRBHHWK

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKD1 - PRBMEAL
(02) HFKD1 - PRBMEAL
(03) HFKC2 - DONTHHWK
(-8) HFKD1 - PRBMEAL
(-9) HFKD1 - PRBMEAL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKD1 - PRBMEAL

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKE1 - PRBSHOP
(02) HFKE1 - PRBSHOP
(03) HFKD2 - DONTMEAL
(-8) HFKE1 - PRBSHOP
(-9) HFKE1 - PRBSHOP

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKE1 - PRBSHOP

Page 22 of 38

2025 MCBS Community Questionnaire

Variable Name

PRBSHOP

DONTSHOP

MR Screen Name

HFKE1

HFKE2

Question Type

code 1

yes/no

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
shopping for personal items (such as toilet items or medicines)?
[You said that shopping for personal items (such as toilet items or medicines) is something that [you don't/(SP)
doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

PRBBILS

DONTBILS

HFKF1

code 1

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
managing money (like keeping track of expenses or paying bills)?

Routing

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKF1 - PRBBILS
(02) HFKF1 - PRBBILS
(03) HFKE2 - DONTSHOP
(-8) HFKF1 - PRBBILS
(-9) HFKF1 - PRBBILS

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFKF1 - PRBBILS

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) BOX HFKA1
(02) BOX HFKA1
(03) HFKF2 - DONTBILS
(-8) BOX HFKA1
(-9) BOX HFKA1

HFKF2

yes/no

[You said that managing money (like keeping track of expenses or paying bills) is something that [you don't/(SP) (01) YES
doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused

BOX HFKA1

routing

IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 - HELPTELE.
ELSE GO TO BOX HFKB1.
[[You said that [your/(SP's)] health makes using the telephone difficult./You said that using the telephone is
something that [you don't do/(SP) doesn't do].]]

HELPTELE

Code List

HFKA3

yes/no

[Do you/Does (SP)] receive help from another person with...
using the telephone?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

BOX HFKA1

(01) HFKA4 - PERSON_HLPRTELE
(02) BOX HFKB1
(-8) BOX HFKB1
(-9) BOX HFKB1

IF PERSON_HLPRTELE = (N+1), GO TO HFKA4_NEWROSTFNAM,
ELSE GO TO BOX HFKB1

PERSON_HLPRT
HFKA4
ELE

roster

You mentioned that [you receive/(SP) receives] help with using the telephone. Who gives that help?
ENTER ALL HELPERS.

ROSTFNAM

HFKA4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKA4_NEW - ROSTLNAM

ROSTLNAM

HFKA4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKA4_NEW - ROSTREL

DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

ROSTREL

HFKA4_NEW

code one

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

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKA4_NEW

text

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

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKB1

routing

IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 - HELPLHWK.
ELSE GO TO BOX HFKC1.

HELPLHWK

HFKB3

yes/no

[[You said that [your/(SP's)] health makes doing light housework (like washing dishes, straightening up, or light
cleaning) difficult./You said that doing light housework (like washing dishes, straightening up, or light cleaning) is
(01) YES
something that [you don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFKB1
(56) BOX HFKB1
(91) HFKA4_NEW - ROSTREOS
(-8) BOX HFKB1
(-9) BOX HFKB1

BOX HFKB1

(01) HFKB4 - PERSON_HLPRLHWK
(02) BOX HFKC1
(-8) BOX HFKC1
(-9) BOX HFKC1

doing light housework (like washing dishes, straightening up, or light cleaning)?

Page 23 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

PERSON_HLPRL
HFKB4
HWK

roster

You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes,
straightening up, or light cleaning). Who gives that help?

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRLHWK = (N+1), GO TO
HFKB4_NEW-ROSTFNAM,
DISPLAY:
ELSE GO TO BOX HFKC1
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

ROSTFNAM

HFKB4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKB4_NEW - ROSTLNAM

ROSTLNAM

HFKB4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKB4_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) BOX HFKC1
(56) BOX HFKC1
(58) BOX HFKC1
(59) BOX HFKC1
(60) BOX HFKC1
(61) BOX HFKC1
(91) HFKB4_NEW - ROSTREOS
(-8) BOX HFKC1
(-9) BOX HFKC1

ROSTREL

HFKB4_NEW

code one

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

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKB4_NEW

text

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

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKC1

BOX HFKC1

routing

IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) BOX HFKD1

HELPHHWK

HFKC3

yes/no

[[You said that [your/(SP's)] health makes doing heavy housework (like scrubbing floors or washing windows)
difficult./You said that heavy housework (like scrubbing floors or washing windows) is something that [you don't
do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
doing heavy housework (like scrubbing floors or washing windows)?

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

PERSON_HLPRH
HFKC4
HWK

roster

You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or
washing windows). Who gives that help?
ENTER ALL HELPERS.

ROSTFNAM

HFKC4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKC4_NEW - ROSTLNAM

ROSTLNAM

HFKC4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKC4_NEW - ROSTREL

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

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFKD1
(56) BOX HFKD1
(58) BOX HFKD1
(59) BOX HFKD1
(60) BOX HFKD1
(61) BOX HFKD1
(91) HFKC4_NEW - ROSTREOS
(-8) BOX HFKD1
(-9) BOX HFKD1

ROSTREL

HFKC4_NEW

code one

DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

IF PERSON_HLPRHHWK = (N+1), GO TO
HFKC4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKD1.

Page 24 of 38

2025 MCBS Community Questionnaire

Variable Name
ROSTREOS

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKD1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) BOX HFKE1

HFKC4_NEW

text

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

BOX HFKD1

routing

IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 - HELPMEAL.
ELSE GO TO BOX HFKE1.
[[You said that [your/(SP's)] health makes preparing [your/[(SP)'s] own meals difficult./You said that preparing
[your/[(SP)'s]] own meals is something that [you don't do/(SP) doesn't do].]]

HELPMEAL

HFKD3

yes/no

[Do you/Does (SP)] receive help from another person with...
preparing [your/[(SP)'s] own meals?

You mentioned that [you receive/(SP) receives] help with preparing [your/[(SP)'s] own meals. Who gives that
help?

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRMEAL = (N+1), GO TO
HFKD4_NEW-ROSTFNAM.
DISPLAY:
ELSE GO TO BOX HFKE1.
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

PERSON_HLPRM
HFKD4
EAL

roster

ROSTFNAM

HFKD4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKD4_NEW - ROSTLNAM

ROSTLNAM

HFKD4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKD4_NEW - ROSTREL

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

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFKE1
(56) BOX HFKE1
(58) BOX HFKE1
(59) BOX HFKE1
(60) BOX HFKE1
(61) BOX HFKE1
(91) HFKD4_NEW - ROSTREOS
(-8) BOX HFKE1
(-9) BOX HFKE1

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKE1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) BOX HFKF1

ROSTREL

ROSTREOS

HELPSHOP

HFKD4_NEW

ENTER ALL HELPERS.

code one

HFKD4_NEW

text

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

BOX HFKE1

routing

IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 - HELPSHOP.
ELSE GO TO BOX HFKF1.

HFKE3

yes/no

[[You said that [your/(SP's)] health makes shopping for personal items (such as toilet items or medicines)
difficult./You said that shopping for personal items (such as toilet items or medicines) is something that [you
don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
shopping for personal items (such as toilet items or medicines)?

You mentioned that [you receive/(SP) receives] help with shopping for personal items (such as toilet items or
medicines). Who gives that help?

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRSHOP = (N+1), GO TO
HFKE4_NEW-ROSTFNAM.
DISPLAY:
ELSE GO TO BOX HFKF1.
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

PERSON_HLPRS
HFKE4
HOP

roster

ROSTFNAM

HFKE4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKE4_NEW - ROSTLNAM

ROSTLNAM

HFKE4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKE4_NEW - ROSTREL

ENTER ALL HELPERS.

Page 25 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing
(01) DO NOT DISPLAY
(02) BOX HFKF1
(56) BOX HFKF1
(58) BOX HFKF1
(59) BOX HFKF1
(60) BOX HFKF1
(61) BOX HFKF1
(91) HFKE4_NEW - ROSTREOS
(-8) BOX HFKF1
(-9) BOX HFKF1

ROSTREL

HFKE4_NEW

code one

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

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKE4_NEW

text

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

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKF1

BOX HFKF1

routing

IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 - HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKF4 - PERSON_HLPRBILS
(02) HFLINTRO - ADLSINTRO
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO

HELPBILS

HFKF3

yes/no

[[You said that [your/(SP's)] health makes managing money (like keeping track of expenses or paying bills)
difficult./You said that managing money (like keeping track of expenses or paying bills) is something that [you
don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
managing money (like keeping track of expenses or paying bills)?

PERSON_HLPRBI
HFKF4
LS

roster

You mentioned that [you receive/(SP) receives] help with managing money (like keeping track of expenses or
paying bills). Who gives that help?
ENTER ALL HELPERS.

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRBILS = (N+1), GO TO HFKF4_NEWROSTFNAM.
DISPLAY:
ELSE GO TO HFLINTRO - ADLSINTRO.
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

ROSTFNAM

HFKF4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKF4_NEW - ROSTLNAM

ROSTLNAM

HFKF4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKF4_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) HFLINTRO - ADLSINTRO
(56) HFLINTRO - ADLSINTRO
(58) HFLINTRO - ADLSINTRO
(59) HFLINTRO - ADLSINTRO
(60) HFLINTRO - ADLSINTRO
(61) HFLINTRO - ADLSINTRO
(91) HFKF4_NEW - ROSTREOS
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
HFLINTRO - ADLSINTRO

ROSTREL

HFKF4_NEW

code one

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

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKF4_NEW

text

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

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

ADLSINTRO

HFLINTRO

no entry

Remembering that health problems can include physical, mental, emotional, or memory problems, I'd now like to
(01) CONTINUE
ask you about how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d
(-7) Empty
like to know whether [you have/(SP) has] any difficulty doing each activity alone and without special equipment.

HPPDBATH

DONTBATH

HFLA1

HFLA2

code 1

yes/no

Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
bathing or showering?

[You said that bathing or showering is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

HFLA1 - HPPDBATH

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFLB1 - HPPDDRES
(02) HFLB1 - HPPDDRES
(03) HFLA2 - DONTBATH
(-8) HFLB1 - HPPDDRES
(-9) HFLB1 - HPPDDRES

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLB1 - HPPDDRES

Page 26 of 38

2025 MCBS Community Questionnaire

Variable Name

HPPDDRES

DONTDRES

HPPDEAT

DONTEAT

HPPDCHAR

DONTCHAR

HPPDWALK

DONTWALK

HPPDTOIL

DONTTOIL

HELPBATH

MR Screen Name

HFLB1

HFLB2

HFLC1

HFLC2

HFLD1

HFLD2

HFLE1

HFLE2

HFLF1

Question Type

code 1

yes/no

code 1

yes/no

code 1

yes/no

code 1

code 1

code 1

HFLF2

yes/no

BOX HFLA1

routing

HFLA3

yes/no

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
dressing?

[You said that dressing is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
eating?

[You said that eating is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
getting in or out of bed or chairs?

[You said that getting in or out of bed or chairs is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
walking?

[You said that walking is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
using the toilet, including getting up and down?

[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

EQIPBATH

HFLA4

yes/no

Routing

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFLC1 - HPPDEAT
(02) HFLC1 - HPPDEAT
(03) HFLB2 - DONTDRES
(-8) HFLC1 - HPPDEAT
(-9) HFLC1 - HPPDEAT

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLC1 - HPPDEAT

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFLD1 - HPPDCHAR
(02) HFLD1 - HPPDCHAR
(03) HFLC2 - DONTEAT
(-8) HFLD1 - HPPDCHAR
(-9) HFLD1 - HPPDCHAR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLD1 - HPPDCHAR

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFLE1 - HPPDWALK
(02) HFLE1 - HPPDWALK
(03) HFLD2 - DONTCHAR
(-8) HFLE1 - HPPDWALK
(-9) HFLE1 - HPPDWALK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLE1 - HPPDWALK

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFLF1 - HPPDTOIL
(02) HFLF1 - HPPDTOIL
(03) HFLE2 - DONTWALK
(-8) HFLF1 - HPPDTOIL
(-9) HFLF1 - HPPDTOIL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLF1 - HPPDTOIL

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) BOX HFLA1
(02) BOX HFLA1
(03) HFLF2 - DONTTOIL
(-8) BOX HFLA1
(-9) BOX HFLA1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLA1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFLA5 - EQIPBATH
(02) HFLA4 - PCHKBATH
(-8) HFLA4 - PCHKBATH
(-9) HFLA4 - PCHKBATH

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLA5 - EQIPBATH

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLA2

IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 - HELPBATH.
ELSE GO TO BOX HFLB1.
[[You said [your/(SP's)] health makes bathing or showering difficult./You said that bathing or showering is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or showering?

PCHKBATH

Code List

Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or showering?
[That is, does someone usually stay or come into the room to check on [you/(SP)?]

HFLA5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/(SP)] with bathing or showering?

BOX HFLA2

routing

IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.

Page 27 of 38

2025 MCBS Community Questionnaire

Variable Name

LONGBATH

STILBATH

HELPDRES

MR Screen Name

HFLA6

Question Type

code 1

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

How long [have you/has (SP)] needed help with bathing or showering? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLA7 - STILBATH
(02) BOX HFLB1
(03) BOX HFLB1
(-8) BOX HFLB1
(-9) BOX HFLB1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLB1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFLB5 - EQIPDRES
(02) HFLB4 - PCHKDRES
(-8) HFLB4 - PCHKDRES
(-9) HFLB4 - PCHKDRES

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLB5 - EQIPDRES

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLB2

How long [have you/has (SP)] needed help with dressing? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLB7 - STILDRES
(02) BOX HFLC1
(03) BOX HFLC1
(-8) BOX HFLC1
(-9) BOX HFLC1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLC1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFLC5 - EQIPEAT
(02) HFLC4 - PCHKEAT
(-8) HFLC4 - PCHKEAT
(-9) HFLC4 - PCHKEAT

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLC5 - EQIPEAT

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLC2

How long [have you/has (SP)] needed help with eating? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLC7 - STILEAT
(02) BOX HFLD1
(03) BOX HFLD1
(-8) BOX HFLD1
(-9) BOX HFLD1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLD1

HFLA7

yes/no

Do you expect that [you/(SP)] will still need help with bathing or showering three months from now?

BOX HFLB1

routing

IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 - HELPDRES.
ELSE GO TO BOX HFLC1.

HFLB3

yes/no

[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with dressing?

PCHKDRES

EQIPDRES

LONGDRES

STILDRES

HELPEAT

HFLB4

yes/no

Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
[That is, does someone usually stay or come into the room to check on [you/(SP)?]

HFLB5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/(SP)] with dressing?

BOX HFLB2

routing

IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.

HFLB6

code 1

HFLB7

yes/no

Do you expect that [you/(SP)] will still need help with dressing three months from now?

BOX HFLC1

routing

IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.

HFLC3

yes/no

[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP) doesn't]
do.]]
[Do you/Does (SP)] receive help from another person with eating?

PCHKEAT

EQIPEAT

LONGEAT

STILEAT

HFLC4

yes/no

Does someone usually stay nearby just in case [you need/(SP) needs] help with eating?
[That is, does someone usually stay or come into the room to check on [you/(SP)]?]

HFLC5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/(SP)] with eating?

BOX HFLC2

routing

IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.

HFLC6

code 1

HFLC7

yes/no

Do you expect that [you/(SP)] will still need help with eating three months from now?

BOX HFLD1

routing

IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 - HELPCHAR.
ELSE GO TO BOX HFLE1.

Page 28 of 38

2025 MCBS Community Questionnaire

Variable Name
HELPCHAR

MR Screen Name
HFLD3

Question Type
yes/no

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

[[You said [your/(SP's)] health makes getting in or out of bed or chairs difficult./You said that getting in or out of
bed or chairs is something [you don't/(SP) doesn't] do.]]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFLD5 - EQIPCHAR
(02) HFLD4 - PCHKCHAR
(-8) HFLD4 - PCHKCHAR
(-9) HFLD4 - PCHKCHAR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLD5 - EQIPCHAR

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLD2

How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLD7 - STILCHAR
(02) BOX HFLE1
(03) BOX HFLE1
(-8) BOX HFLE1
(-9) BOX HFLE1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLE1

[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?

PCHKCHAR

HFLD4

yes/no

Does someone usually stay nearby just in case [you need/(SP) needs] help with getting in or out of bed or
chairs?
[That is, does someone usually stay or come into the room to check on [you/(SP))?]]

EQIPCHAR

LONGCHAR

STILCHAR

HFLD5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/(SP)] with getting in or out of bed or chairs?

BOX HFLD2

routing

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.

HFLD6

code 1

HFLD7

yes/no

Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three months from now?

BOX HFLE1

routing

IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.
[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "NO"
WITHOUT READING TEXT BELOW.]

HELPWALK

HFLE3

yes/no

(01) YES
(02) NO
[[You said [your/(SP's)] health makes walking difficult./You said that walking is something [you don't/(SP) doesn't]
(-8) Don't Know
do.]]
(-9) Refused

(01) HFLE5 - EQIPWALK
(02) HFLE4 - PCHKWALK
(-8) HFLE4 - PCHKWALK
(-9) HFLE4 - PCHKWALK

[Do you/Does (SP)] receive help from another person with walking?
[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "NO"
WITHOUT READING TEXT BELOW.]
PCHKWALK

HFLE4

yes/no

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLE5 - EQIPWALK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLE2

How long [have you/has (SP)] needed help with walking? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLE7 - STILWALK
(02) BOX HFLF1
(03) BOX HFLF1
(-8) BOX HFLF1
(-9) BOX HFLF1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLF1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFLF5 - EQIPTOIL
(02) HFLF4 - PCHKTOIL
(-8) HFLF4 - PCHKTOIL
(-9) HFLF4 - PCHKTOIL

Does someone usually stay nearby just in case [you need/(SP) needs] help with walking?
[That is, does someone usually stay or come into the room to check on [you/(SP))?]]

EQIPWALK

HFLE5

yes/no

[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "YES"
WITHOUT READING TEXT BELOW.]
[Do you/Does (SP)] use special equipment or aids to help [you/(SP)] with walking?

BOX HFLE2

LONGWALK

STILWALK

HELPTOIL

HFLE6

routing

code 1

IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.

HFLE7

yes/no

Do you expect that [you/(SP)] will still need help with walking three months from now?

BOX HFLF1

routing

IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 - HELPTOIL.
ELSE GO TO BOX HFLA3.

HFLF3

yes/no

[[You said [your/(SP's)] health makes using the toilet difficult./You said that using the toilet is something [you
don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with using the toilet, including getting up and down?

PCHKTOIL

HFLF4

yes/no

Does someone usually stay nearby just in case [you need/(SP) needs] help with using the toilet, including getting (01) YES
up and down?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on [you/(SP)]?]
(-9) Refused

HFLF5 - EQIPTOIL

Page 29 of 38

2025 MCBS Community Questionnaire

Variable Name
EQIPTOIL

LONGTOIL

STILTOIL

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

HFLF5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/(SP)] with using the toilet, including getting up
and down?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLF2

BOX HFLF2

routing

IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.

How long [have you/has (SP)] needed help with using the toilet? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLF7 - STILTOIL
(02) BOX HFLA3
(03) BOX HFLA3
(-8) BOX HFLA3
(-9) BOX HFLA3

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLA3

HFLF6

code 1

HFLF7

yes/no

Do you expect that [you/(SP)] will still need help with using the toilet three months from now?

BOX HFLA3

routing

IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.

You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRBATH = (N+1) , GO TO
HFLA9_NEW-ROSTFNAM.
DISPLAY:
ELSE GO TO BOX HFLB3.
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

PERSON_HLPRB
HFLA9
ATH

roster

ROSTFNAM

HFLA9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLA9_NEW - ROSTLNAM

ROSTLNAM

HFLA9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLA9_NEW - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFLB3
(56) BOX HFLB3
(58) BOX HFLB3
(59) BOX HFLB3
(60) BOX HFLB3
(61) BOX HFLB3
(91) HFLA9_NEW - ROSTREOS
(-8) BOX HFLB3
(-9) BOX HFLB3

ENTER ALL HELPERS.

ROSTREL

HFLA9_NEW

code one

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

ROSTREOS

HFLA9_NEW

text

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

BOX HFLB3

routing

IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.

PERSON_HLPRD
HFLB9
RES

roster

You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?
ENTER ALL HELPERS.

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

BOX HFLB3

IF PERSON_HLPRBATH = (N+1), GO TO HFLB9_NEWROSTFNAM.
ELSE GO TO BOX HFLC3.

Page 30 of 38

2025 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

ROSTFNAM

HFLB9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLB9_NEW - ROSTLNAM

ROSTLNAM

HFLB9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLB9_NEW - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFLC3
(56) BOX HFLC3
(58) BOX HFLC3
(59) BOX HFLC3
(60) BOX HFLC3
(61) BOX HFLC3
(91) HFLB9_NEW - ROSTREOS
(-8) BOX HFLC3
(-9) BOX HFLC3

ROSTREL

HFLB9_NEW

code one

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

ROSTREOS

HFLB9_NEW

text

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

BOX HFLC3

routing

IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.

You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

BOX HFLC3

IF PERSON_HLPREAT = (N+1) GO TO HFLC9_NEWROSTFNAM.
ELSE GO TO BOX HFLD3.

PERSON_HLPRE
HFLC9
AT

roster

ROSTFNAM

HFLC9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLC9_NEW - ROSTLNAM

ROSTLNAM

HFLC9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLC9_NEW - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFLD3
(56) BOX HFLD3
(58) BOX HFLD3
(59) BOX HFLD3
(60) BOX HFLD3
(61) BOX HFLD3
(91) HFLC9_NEW - ROSTREOS
(-8) BOX HFLD3
(-9) BOX HFLD3

ENTER ALL HELPERS.

ROSTREL

HFLC9_NEW

code one

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

ROSTREOS

HFLC9_NEW

text

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

BOX HFLD3

routing

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.

PERSON_HLPRC
HFLD9
HAR

roster

You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that help?
ENTER ALL HELPERS.

DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

BOX HFLD3

IF PERSON_HLPRCHAR = (N+1) , GO TO
HFLD9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLE3.

Page 31 of 38

2025 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

ROSTFNAM

HFLD9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLD9_NEW - ROSTLNAM

ROSTLNAM

HFLD9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLD9_NEW - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFLE3
(56) BOX HFLE3
(58) BOX HFLE3
(59) BOX HFLE3
(60) BOX HFLE3
(61) BOX HFLE3
(91) HFLD9_NEW - ROSTREOS
(-8) BOX HFLE3
(-9) BOX HFLE3

ROSTREL

HFLD9_NEW

code one

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

ROSTREOS

HFLD9_NEW

text

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

BOX HFLE3

routing

IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.

You mentioned that [you receive/(SP) receives] help with walking. Who gives that help?

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

BOX HFLE3

IF PERSON_HLPRWALK = (N+1), GO TO
HFLE9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLF3.

PERSON_HLPR
WALK

HFLE9

roster

ROSTFNAM

HFLE9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLE9_NEW - ROSTLNAM

ROSTLNAM

HFLE9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLE9_NEW - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFLF3
(56) BOX HFLF3
(58) BOX HFLF3
(59) BOX HFLF3
(60) BOX HFLF3
(61) BOX HFLF3
(91) HFLE9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3

ROSTREL

ROSTREOS

HFLE9_NEW

code one

ENTER ALL HELPERS.

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

HFLE9_NEW

text

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

BOX HFLF3

routing

IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.

PERSON_HLPRT
HFLF9
OIL

roster

ROSTFNAM

text

HFLF9_NEW

You mentioned that [you receive/(SP) receives] help with using the toilet. Who gives that help?
ENTER ALL HELPERS.

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

DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(01) CONTINUOUS ANSWER

BOX HFLF3

IF PERSON_HLPRTOIL = (N+1), GO TO HFLF9_NEWROSTFNAM.
ELSE GO TO BOX HFLG3.

HFLF9_NEW - ROSTLNAM

Page 32 of 38

2025 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

ROSTLNAM

HFLF9_NEW

text

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

(01) CONTINUOUS ANSWER

HFLF9_NEW - ROSTREL

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) DO NOT DISPLAY
(02) BOX HFLF3
(56) BOX HFLF3
(58) BOX HFLF3
(59) BOX HFLF3
(60) BOX HFLF3
(61) BOX HFLF3
(91) HFLF9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3

ROSTREL

HFLF9_NEW

code one

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

ROSTREOS

HFLF9_NEW

text

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

BOX HFL4

routing

IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9, HFLD9, HFLE9, AND/OR HFLF9, GO
TO HFL10 - PERSON_HLPRMOST.
ELSE GO TO HFM1 - FALLANY.

PERSON_HLPRM
HFL10
OST

roster

FALLANY

HFM1

yes/no

FALLTIME

HFM2

numeric

FALLHELP

HFM3A

yes/no

Which of these persons gives [you/(SP)] the most help with these things?
SELECT ONLY ONE.
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down?
ENTER "95" IF 95 OR MORE FALLS REPORTED.

HFM3B

FALLIMIT

FALLBACK

FALLFEAR

HFM3B

HFM3C

HFM3D

HFM3E

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFM2 - FALLTIME
(02) DISUPPYR
(-8) DISUPPYR
(-9) DISUPPYR

[Continuous answer.]
Don't Know
Refused

HFM3A - FALLHELP

HFM3B - FALCODE

(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
(03) BRUISE
(04) CUT/WOUND/LACERATION
(05) CONCUSSION
(06) DISLOCATION
(91) OTHER
(96) NO INJURY
(-8) Don't Know
(-9) Refused

(01) HFM3C - FALLIMIT
(02) HFM3C - FALLIMIT
(03) HFM3C - FALLIMIT
(04) HFM3C - FALLIMIT
(05) HFM3C - FALLIMIT
(06) HFM3C - FALLIMIT
(91) HFM3B - FALOTHOS
(96) HFM3C - FALLIMIT
(-8) HFM3C - FALLIMIT
(-9) HFM3C - FALLIMIT

OTHER (SPECIFY)

(01) [Continuous answer.]

HFM3C - FALLIMIT

Did [your/(SP's)] [most recent] fall cause [you/(SP)] to limit [your/(SP)'s] regular activities?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFM3D - FALLBACK
(02) HFM3E - FALLFEAR
(-8) HFM3E - FALLFEAR
(-9) HFM3E - FALLFEAR

code 1

How long did it take [you/(SP)] to get back to regular activities after [your/(SP)'s] [most recent] fall?

(01) LESS THAN ONE WEEK
(02) ONE WEEK OR MORE
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused

HFM3E - FALLFEAR

numeric

(01) [Continuous answer.]
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is "Not at all afraid of falling" and 6 is
(-8) Don't Know
"Extremely afraid of falling"?
(-9) Refused

code all

[PROBE: Anything else?]
CHECK ALL THAT APPLY.

FALOTHOS

BOX HFLF3

Display all persons selected at HFLA9, HFLB9, HFLC9,
HFM1 - FALLANY
HFLD9, HFLE9 and HFLF9 rosters.

(01) YES
Thinking about the [most recent) time that [you/(SP)] fell, did [you/(SP)] hurt [yourself/ themselves] badly enough (02) NO
to get medical help?
(-8) Don't Know
(-9) Refused

What kind of injury did [you/(SP)] have in that [most recent] fall?
FALCODE

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

verbatim text

yes/no

DISUPPYR

SHOW CARD HF10
This card lists some examples of different types of dietary supplements.
DISUPPYR

DISUPPYR

yes/no

Since (LAST HF MONTH YEAR), [have you/has (SP)] used or taken any vitamins, minerals, herbals or other
dietary supplements? Include prescription and non-prescription supplements.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) MULTVTYR
(02) BOX MH1
(-8) BOX MH1
(-9) BOX MH1

[IF NEEDED: Include any supplements that you have already told me about.]

Page 33 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
Since (LAST HF MONTH YEAR), did [you/(SP)] take any multivitamins, such as One a Day, Theragran, or
Centrum type multivitamins?

MULTVTYR

MULTVTYR

yes/no

[IF NEEDED: Multivitamins may be pills, liquids, or packets]
[IF NEEDED: Include any multivitamins that you have already told me about.]

SHOW CARD HF11
Please look at the vitamins and dietary supplements listed on this card. Since (LAST HF MONTH YEAR), what
vitamins and dietary supplements did [you/(SP)] take at least once?
Do not include vitamins and dietary supplements that are taken as part of a multivitamin.
VITSUPYR

VITSUPYR

select all

[IF NEEDED: Include any vitamins or dietary supplements (that are not part of a multivitamin) that you have
already told me about.]
IF RESPONDENT HAS PROVIDED YOU WITH SUPPLEMENT BOTTLES YOU MAY USE THOSE TO
ANSWER THE QUESTION IF THE SUPPLEMENT WAS TAKEN SINCE (LAST HF MONTH YEAR).
DO NOT INCLUDE MEDICATIONS (E.G., ASPIRIN, ALLEGRA, TYLENOL, ETC.)
SELECT ALL THAT APPLY

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

VITSUPYR

(01) Calcium (with or without vitamin D)
(02) Choline
(03) Coenzyme Q (such as CoQ10)
(04) Eye health supplement (such as Ocuvite
PreserVision or I-Caps)
(05) Fiber supplement (such as Metamucil or Benefiber)
(06) Folate or folic acid
(07) Garlic supplement
(08) Iron
(09) Joint supplement (such as glucosamine, with or
without chondroitin or other ingredients)
(10) Magnesium
(11) Melatonin
(12) Niacin
(13) Omega-3 (ALA/DHA/EPA) or fish oil
(14) Potassium
(15) Probiotics (in pill, powder, or liquid form)
(16) Saw palmetto
(17) Vitamin A
(18) Vitamin B-12
(19) Vitamin B-complex
(20) Vitamin C
(21) Vitamin D (NOT as part of a calcium supplement)
(22) Vitamin E
(23) Zinc
(24) NOT APPLICABLE; RESPONDENT ONLY TAKES
MULTIVITAMINS
(91) Other Supplement(s)
(-8) Don't Know
(-9) Refused

(01)-(23) BOX MH1
(91) VITOTHOS
(-8) BOX MH1
(-9) BOX MH1

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

VITOTHO2

What were the names of those other supplements?
ENTER UP TO 5 ADDITIONAL SUPPLEMENTS AT THIS SCREEN.
VITOTHOS

VITOTHOS

text

IF RESPONDENT REPORTS MORE THAN 5 OTHER SUPPLEMENTS, ENTER THE SUPPLEMENTS THAT
WERE TAKEN THE MOST OFTEN SINCE (LAST HF MONTH YEAR).
DO NOT INCLUDE MEDICATIONS (E.G., ASPIRIN, ALLEGRA, TYLENOL, ETC.)
[INSERT TEXT BOX 1 FOR SUPPLEMENT 1]

VITOTHO2

VITOTHOS

text

[INSERT TEXT BOX 2 FOR SUPPLEMENT 2]

(01) [Continuous answer.]
(-7) Empty

VITOTHO3

VITOTHO3

VITOTHOS

text

[INSERT TEXT BOX 3 FOR SUPPLEMENT 3]

(01) [Continuous answer.]
(-7) Empty

VITOTHO4

VITOTHO4

VITOTHOS

text

[INSERT TEXT BOX 4 FOR SUPPLEMENT 4]

(01) [Continuous answer.]
(-7) Empty

VITOTHO5

VITOTHO5

VITOTHOS

text

[INSERT TEXT BOX 5 FOR SUPPLEMENT 5]

(01) [Continuous answer.]
(-7) Empty

BOX MH1

BOX MH1

routing

If the respondent is a proxy (SPPROXY=2), go to HFQ1 - LOSTURIN.
Else go to HFN1 - HFGAD1.
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN2 - HFGAD2

The next few questions ask about the last two weeks.
HFGAD1

HFN1

list

SHOW CARD HF12
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious, or on edge

Page 34 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
SHOW CARD HF12

HFGAD2

HFN2

list

[Over the last 2 weeks, how often have you been bothered by the following problems?]
Not being able to stop or control worrying.
SHOW CARD HF12

HFPHQ1

HFN3

list

Now, we will ask you about how the following problems have affected you overall, if any at all. Over the last 2
weeks, how often have you been bothered by the following problems:
little interest or pleasure in doing things? Would you say…
SHOW CARD HF12

HFPHQ2

HFN4

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling down, depressed, or hopeless?
SHOW CARD HF12

HFPHQ3

HFN5

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
trouble falling or staying asleep, or sleeping too much?
SHOW CARD HF12

HFPHQ4

HFN6

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling tired or having little energy?
SHOW CARD HF12

HFPHQ5

HFN7

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
poor appetite or overeating?
SHOW CARD HF12

HFPHQ6

HFN8

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling bad about yourself – or that you are a failure or have let yourself or your family down?
SHOW CARD HF12

HFPHQ7

HFN9

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
trouble concentrating on things, such as reading the newspaper or watching TV?
SHOW CARD HF12

HFPHQ8

HFN10

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or
restless that you have been moving around a lot more than usual?

BOX HFPHQ

routing

Code List

Routing

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN3 - HFPHQ1

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN4 - HFPHQ2

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN5 - HFPHQ3

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN6 - HFPHQ4

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN7 - HFPHQ5

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN8 - HFPHQ6

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN9 - HFPHQ7

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN10 - HFPHQ8

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

BOX HFPHQ

IF SP REPORTED [(02/Several Days), (03/More than half the days), or (04/Nearly Every Day)] TO AT LEAST
ONE ITEM IN HFPHQ1 THROUGH HFPHQ8, GO TO HFN11-PHQ9QS10.
ELSE GO TO HFQ1 – SOCISOLA.
SHOW CARD HF13

PHQ9QS10

HFN11

code one

(01) Not at all difficult,
(02) Somewhat difficult,
You mentioned that you have been bothered by the following problems over the last 2 weeks:
[LIST ALL CONDITIONS WHERE ANSWER RECORDED DOES NOT EQUAL 1/NOT AT ALL, -8/REFUSED, or - (03) Very difficult,
9/DON’T KNOW, AT HFPHQ1 THROUGH HFPHQ8]
(04) Extremely difficult?
(-8) REFUSED
How difficult have these problems made it for you to do your work, take care of things at home, or get along with (-9) DON’T KNOW
people?

SOCISOLA-SOCISOLA

Page 35 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description
SHOW CARD HF14

SOCISOLA

SOCISOLA

code 1

Since (LAST HF MONTH YEAR), how often have you felt lonely or isolated from those around you? Would you
say...

SHOW CARD HF15
LOSTURIN

TALKURIN

FEELURIN

REASURIN

SURGURIN

HFQ1

HFQ2

HFQ3

HFQ4

HFQ5

code 1

I'd like to ask about a health problem that is more common than people think. Please look at this card and tell
me how often, if at all, since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine because [you/(SP)] could
not control [your/(SP)'s] bladder.

Code List

Routing

(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(-8) Don’t know
(-9) Refused

HFQ1 - LOSTURIN

(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
(06) ONCE OR TWICE A YEAR
(07) NOT AT ALL
(08) SP IS ON DIALYSIS OR CATHETERIZATION OR
UROSTOMY OR BLADDER BAG
(-8) Don't Know
(-9) Refused

(01) HFQ2 - TALKURIN
(02) HFQ2 - TALKURIN
(03) HFQ2 - TALKURIN
(04) HFQ2 - TALKURIN
(05) HFQ2 - TALKURIN
(06) HFQ2 - TALKURIN
(07) HFQBI-PROBFECE
(08) HFQBI-PROBFECE
(-8) HFQBI-PROBFECE
(-9) HFQBI-PROBFECE
(01) HFQ3 - FEELURIN
(02) HFQBI-PROBFECE
(-8) HFQBI-PROBFECE
(-9) HFQBI-PROBFECE

yes/no

[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other health professional?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

yes/no

Has [your/(SP’s)] doctor or other health professional asked [you/(SP)] about how [you/(SP)] feel[s] about this
problem?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFQ4 - REASURIN

yes/no

(01) YES
Has [your/(SP’s)] doctor or other health professional examined [you/(SP)] to figure out why [you/(SP)] [lose/loses] (02) NO
urine?
(-8) Don't Know
(-9) Refused

HFQ5 - SURGURIN

yes/no

Has [your/(SP’s)] doctor or other health professional talked with [you/(SP)] about taking medicine or having
surgery for this problem?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFQBI-PROBFECE

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFQBI- SMLSTOOL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFQBI-MODSTOOL

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFQBI-LRGSTOOL

We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements.
PROBFECE

HFQBI

grid

Since (LAST HF MONTH YEAR), [have you/has (SP)] had any of the following problems?
[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
SUCH AS THE FLU OR A VIRUS.Leaking gas?
We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements.
Since (LAST HF MONTH YEAR), have [you/(SP)] had any of the following problems?

SMLSTOOL

HFQBI

grid

[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
SUCH AS THE FLU OR A VIRUS.
Leaking a small ammount of stool?
We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements.
Since (LAST HF MONTH YEAR), have [you/(SP)] had any of the following problems?

MODSTOOL

HFQBI

grid

[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
SUCH AS THE FLU OR A VIRUS.
Leaking a moderate amount of stool, requiring a change of underwear?

Page 36 of 38

2025 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFQBI

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFT1

(01) YES
(02) NO
(03) SP NEVER HAD HIGH BLOOD
PRESSURE/PREVIOUS RESPONSE ENTERED IN
ERROR
(-8) Don't Know
(-9) Refused

(01) HFT2 - HYPEAGE
(02) HFT2 - HYPEAGE
(03) BOX HFEND
(-8) HFT2 - HYPEAGE
(-9) HFT2 - HYPEAGE

We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements.
Since (LAST HF MONTH YEAR), have [you/(SP)] had any of the following problems?
LRGSTOOL

HFQBI

grid

[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
SUCH AS THE FLU OR A VIRUS.
Leaking a large amount of liquid stool, requiring a complete change of clothes?

BOX HFQBI

TALKFECE

routing

IF AT LEAST ONE TYPE OF STOOL LEAKAGE IS SELECTED IN HFQBI GRID (PROBFECE=1 OR
SMLSTOOL=1 OR MODSTOOL= 1 OR LRGSTOOL=1), GO TO TALKFECE-TALKFECEELSE, GO TO BOX
HFT1.

TALKFECE

yes/no

[Have you/Has (SP)] talked about [your/his/her] problem with stool leakage with [your/his/her] doctor or other
health professional?[IF NECESSARY: This is also referred to as bowel or fecal incontinence.]

BOX HFT1

routing

IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.
We have recorded that [you were/(SP) was] told by a doctor or other health professional that [you had/(SP) had]
hypertension, also called high blood pressure.

HYPETOLD

HFT1

code 1

[Were you/Was (SP)] told on two or more different medical visits that [you/(SP)] had high blood pressure or
hypertension?
[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)] blood pressure was high for
more than one reading.]

HFT2

numeric

How old [were you/was (SP)] when [you were/(SP) was] first told that [you/(SP)] had high blood pressure?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFT2 - HYPEAGE_LESSONE

HYPEAGE_LESS
HFT2
ONE

numeric

How old [were you/was (SP)] when (you were/(SP) was) first told that [you/(SP)] had high blood pressure?

(01) LESS THAN ONE YEAR OLD
(-7) Empty

HFT6D - HYPEHOME

yes/no

Because of [your/(SP)'s] high blood pressure, [are you/is (SP)] now measuring [your/(SP)'s] blood pressure at
home?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFT6G - HYPEMEDS

yes/no

Because of [your/(SP)'s] high blood pressure, [are you/is (SP)] now taking prescribed medicine for [your/(SP)'s]
high blood pressure?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFT6J - HYPEDRNK

(01) YES
(02) NO
(03) NOT APPLICABLE; RESPONDENT DOES NOT
DRINK ALCOHOL
(-8) Don't Know
(-9) Refused

BOX HFT2

HYPEAGE

HYPEHOME

HYPEMEDS

HYPEDRNK

HFT6D

HFT6G

HFT6J

yes/no

[Have you/Has (SP)] cut down on drinking alcoholic beverages because of [your/(SP)'s] high blood pressure?]

BOX HFT2

routing

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.

HFT7

numeric

How long [have you/has (SP)] been treated with prescribed medicines for [your/(SP)'s] high blood pressure?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFT7 - HYPELONG_LESSONE

HYPELONG_LES
HFT7
SONE

numeric

How long [have you/has (SP)] been treated with prescribed medicines for [your/(SP)'s] high blood pressure?

(01) LESS THAN ONE YEAR
(-7) Empty

BOX HFT3

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFT8 - HYPEMANY.
ELSE GO TO HFT11A - HYPECOND.

HYPELONG

BOX HFT3

How many different prescribed medicines [do you/does (SP)] take for [your/(SP)'s] high blood pressure?
HYPEMANY

HFT8

numeric

(01) [Continuous answer.]
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD
(-8) Don't Know
PRESSURE ARE TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN ONE (-9) Refused
DAY.]

HFT11A - HYPECOND

Page 37 of 38

2025 MCBS Community Questionnaire

Variable Name

HYPECOND

HYPECTRL

MR Screen Name

HFT11A

HFT12A

Question Type

code 1

code 1

HFQ-HEALTH STATUS AND FUNCTIONING

Question Text/Description

Code List

Routing

How often [do you/does (SP)] have trouble with side effects from [your/(SP)'s] blood pressure medicines[s]?
Please tell me if [you/(SP)] always, sometimes, or never [have/has] trouble with side effects.

(01) ALWAYS
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused

HFT12A - HYPECTRL

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

BOX HFT4

[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such as fatigue,
headache, or coughing.]
Doctors and other health professionals often recommend changing your habits or lifestyle, such as changing
your diet, or getting regular exercise in order to control blood pressure. How confident are you that [you/(SP)]
can follow these recommendation?
Would you say that you are very confident, confident, somewhat confident, or not at all confident?

routing

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.

yes/no

[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/(SP)] doctor or other health professional
prescribes for [your/(SP)'s] high blood pressure?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFT14 - HYPESKIP

HFT14

yes/no

[Do you/Does (SP)] ever skip taking [your/(SP)'s] medicine, take less medicine than prescribed, or share
medicine because of the cost of the medicine?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFEND

BOX HFEND

routing

If INTTYPE in (C003), GO TO PXQ
ELSE, GO TO NAQ.

BOX HFT4

HYPEPAY

HYPESKIP

HFT13

Page 38 of 38