CMS-P-0015A Interviewer_Remarks

2023 MCBS Facility Instrument

Variable Name

IR-Interviewer Remarks

MR Screen Name Question Type

Question Text/Description

Code List

Routing

INTERVIEWER REMARKS SECTION SPECIFICATIONS
CRITERIA
(N/A)
PLACEMENT
(N/A)

BOX IRQBEG

routing

GO TO MULTMODE

MULTMODE

MULTMODE

code one

WHICH OF THE FOLLOWING MODES DID YOU USE TO COMPLETE THIS INTERVIEW? DO NOT INCLUDE
MODES USED FOR GAINING COOPERATION OR SETTING APPOINTMENTS.

(01) PHONE ONLY
(02) IN-PERSON ONLY
(03) PHONE AND IN-PERSON

(01) IRQ19-WORKREM
(02) IRQ19-WORKREM
(03) IRQ19-WORKREM

WORKREM

IRQ19

yes/no

DURING THE INTERVIEW, WERE ANY OF THE FACILITY RESPONDENTS WORKING REMOTELY?

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

(00) IRQ15 - MDSABST
(01) IRQ20 - ELECREC
(-8) IRQ15 - MDSABST
(-9) IRQ15 - MDSABST

(01) BILLING INFORMATION
(02) MEDICAL CHART
(03) MDS
(04) NOT APPLICABLE
(91) OTHER
(96) NONE OF THE ABOVE
(-8) DON'T KNOW

(01) BOX IRQ2
(02) BOX IRQ2
(03) BOX IRQ2
(04) BOX IRQ2
(91) BOX IRQ2
(96) BOX IRQ2
(-8) BOX IRQ2

IRQ20

code all

WHICH ELECTRONIC RECORDS DID THE FACILITY RESPONDENTS HAVE ACCESS TO WHILE WORKING
REMOTELY?

BOX IRQ2

routing

IF IRQ20 - ELECREC INCLUDES 91/OTHER, THEN GO TO IRQ21 - ELCROS
ELSE GO TO IRQ15 - MDSABST

ELCROS

IRQ21

text

WHICH ELECTRONIC RECORD(S) WERE USED?

(01) Continuous Answer

(00) IRQ15 - MDSABST

MDSABST

IRQ15

yes/no

DID YOU USE INFORMATION FROM AN MDS FOR ANY PART OF THIS INTERVIEW?

(00) NO
(01) YES

(00) IRQ3 - FUTUREF
(01) IRQ16 - MDSELEC

MDSELEC

IRQ16

yes/no

DID THIS FACILITY USE AN ELECTRONIC MDS?

(00) NO
(01) YES

(00) IRQ3 - FUTUREF
(01) IRQ17 - ELECHOW

HOW DID YOU ACCESS THE ELECTRONIC MDS? SELECT ALL THAT APPLY.

(01) THE FACILITY PRINTED IT OUT FOR ME
(02) THE FACILITY STAFF READ THE MDS TO ME
(03) THE FACILITY GRANTED ME ACCESS TO THEIR
ELECTRONIC SYSTEM WITHOUT STAFF
SUPERVISION
(04) THE FACILITY GRANTED ME ACCESS TO THEIR
ELECTRONIC SYSTEM WITH STAFF SUPERVISION
(05) OTHER

(01) IRQ3 - FUTUREF
(02) IRQ3 - FUTUREF
(03) IRQ3 - FUTUREF
(04) IRQ3 - FUTUREF
(05) IRQ18 - ELECOTH

ELECREC

ELECHOW

IRQ17

code all

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2023 MCBS Facility Instrument

IR-Interviewer Remarks

Variable Name

MR Screen Name Question Type

Question Text/Description

Code List

Routing

ELECOTH

IRQ18

verbatim text

OTHER SPECIFY

(01) Continuous Answer

(01) IRQ3 - FUTUREF

FUTUREF

IRQ3

yes/no

ARE THERE ANY COMMENTS YOU WOULD LIKE TO MAKE ABOUT THE RESPONDENT(S) OR
INTERVIEWING SITUATION THAT COULD HELP THE NEXT INTERVIEWER COMPLETE THIS CASE?

(00) NO
(01) YES

(00) BOX IRQ1
(01) IRQ3OV - FUTURVB

FUTURVB

IRQ3OV

verbatim text

PLEASE RECORD THOSE NOTES HERE.

(01) Continuous Answer

(01) IRQ14 - ANYFIX

BOX IRQ1

routing

IF THERE ARE NO PREVIOUS ROUND DRIVING DIRECTIONS AVAILABLE, GO TO IRQ14B - DRIVE.
ELSE GO TO IRQ14C - DRIVCHNG.

IRQ14B

yes/no

ARE THERE ANY DRIVING INSTRUCTIONS THAT WOULD ASSIST AN INTERVIEWER NEXT ROUND IN
REACHING THE FACILITY?

(00) NO
(01) YES

(00) IRQEND - IRQENDCT
(01) IRQ14D - DRIVETXT

(01) IRQ14D - DRIVETXT
(02) IRQEND - IRQENDCT
(03) IRQEND - IRQENDCT

DRIVE

DRIVCHNG

IRQ14C

yes/no

DO YOU NEED TO UPDATE OR CHANGE THE FOLLOWING DRIVING DIRECTIONS RECORDED IN THE LAST
ROUND?
(01) YES, REPLACE
(02) NO, KEEP THE SAME
PLEASE REMEMBER WHEN UPDATING OR CHANGING DRIVING DIRECTIONS, THE NEW TEXT WILL
(03) REMOVE DRIVING DIRECTIONS
REPLACE THE PREVIOUS TEXT.

DRIVETXT

IRQ14D

verbatim text

ENTER THE DRIVING DIRECTIONS.

(01) Continuous Answer

(01) IRQEND - IRQENDCT

IRQENDCT

IRQEND

code one

YOU HAVE COMPLETED THE IRQ FOR (SP).
PRESS "1" TO RETURN TO NORCSUITE.

(01) Continue

(01) BOX IRQEND

BOX IRQEND

routing

GO TO NORCSUITE

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