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pdf2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) US2 - PLACEKND
(02) BOX USA
(-8) BOX USA
(-9) BOX USA
(01) DOCTOR'S OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY/COMMUNITY HEALTH
CENTER
(05) FREESTANDING SURGICAL CENTER
(06) RURAL HEALTH CLINIC
(07) RETAIL CLINICS
(08) OTHER CLINIC
(09) WALK-IN URGENT CENTER
(10) DOCTOR COMES TO SP'S HOME
(11) HOSPITAL EMERGENCY ROOM
(12) HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
(13) VA FACILITY
(14) MENTAL HEALTH CENTER
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) US5A - MDNAME PVTYPE - PVTYPE
(02) US3A - CLNAME US4 - USUALDOC
(03) US3A - CLNAME US4 - USUALDOC
(04) US3A - CLNAME US4 - USUALDOC
(05) US3A - CLNAME US4 - USUALDOC
(06) US3A - CLNAME US4 - USUALDOC
(07) US3A - CLNAME US4 - USUALDOC
(08) US3A - CLNAME US4 - USUALDOC
(09) US3A - CLNAME US4 - USUALDOC
(10) US5A - MDNAME PVTYPE - PVTYPE
(11) US3A - CLNAME US4 - USUALDOC
(12) US3A - CLNAME US4 - USUALDOC
(13) US3A - CLNAME US4 - USUALDOC
(14) US3A - CLNAME US4 - USUALDOC
(91) US2 - PLACEOS US4 - USUALDOC
(-8) US3A - CLNAME US4 - USUALDOC
(-9) US3A - CLNAME US4 - USUALDOC
(01) CONTINUOUS ANSWER
US3A - CLNAME
USUAL SOURCE OF CARE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C004, C005, C006, C007
SPALIVE=1
SEASON= WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after KNQ.
PLACEPAR
US1
BOX USA
PLACEKND
US2
yes/no
Is there a particular doctor or other health professional, or a clinic [you/(SP)] usually [go/goes] to when [you
are/(SP) is] sick or for advice about [your/(SP)'s] health?
routing
IF (INTTYPE=7) AND SP ever reported speaking a language other than English in the home
(SAMPLE_PERSON.WHATLANG EQUALS 1-16 OR 91-"Other, Specify") AND SP reported that they speak
English well, not well, or not at all (P_ENGWELL=1), GO TO LEP6-LANGPROB.
ELSE GO TO US39 – NUSNOTSK.
code one
What kind of place [do you/does (SP)] usually go to when [you are/(SP) is] sick or for advice about [your/(SP)'s]
health -- is that a managed care plan or HMO center, a clinic, a doctor or other health professional's office, a
hospital, or some other place?
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind of clinic?
IF SOME OTHER PLACE, ASK: Where is this?
PLACEOS
US2
text
OTHER (SPECIFY)
routing
IF SP WAS COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
US2A - PLACEMCP.
ELSE IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.
US2A
yes/no
(01) YES
Is this [doctor or other health professional/medical clinic] associated with [your/(SP)'s] [READ MANAGED CARE (02) NO
PLAN NAME(S) BELOW] plan?
(-8) DON'T KNOW
(-9) REFUSED
BOX USC
routing
IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME.
ELSE GO TO US3A - CLNAME.
BOX USB
PLACEMCP
BOX USC
Page 1 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
What is the complete name of the [place/managed care plan or HMO center/(US2 RESPONSE)] that [you go
to/(SP) goes to]?
CLNAME
US3A
verbatim text
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT
CARD, ETC., FOR COMPLETE INFORMATION.]
Code List
Routing
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
(01) continuous answer
(-8) Don't Know
(-9) Refused
US4 - USUALDOC
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02
USUALDOC
US4
yes/no
Is there a particular doctor or other health professional [you usually see/(SP) usually sees] at this
[place/managed care plan or HMO center/(US2 RESPONSE)]?
What is the complete name of that doctor or other health professional?
MDNAME
US5A
verbatim text
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT
CARD, ETC., FOR COMPLETE INFORMATION.]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) US5A - MDNAME PVTYPE - PVTYPE
(02) BOX USD
(-8) BOX USD
(-9) BOX USD
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
(01) continuous answer
(-8) Don't Know
(-9) Refused
MDSEX - US5B
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02
MDSEX
US5B
code one
Is (US5A PROVIDER NAME) a male or female?
(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED
US6A - PVSPEC
Page 2 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Is [your/(SP)'s] provider a physician or medical doctor (MD), doctor of osteopathy (DO), physician's assistant
(PA), nurse practitioner, or some other health professional?
SHOW CARD US1
PVSPEC PVTYPE
US6A PVTYPE
code one
What is (US5A PROVIDER NAME) specialty?
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]
Code List
Routing
(01) ALLERGY/IMMUNOLOGY PHYSICIAN/MEDICAL
DOCTOR (MD)
(02) ANESTHESIOLOGY DOCTOR OF OSTEOPATHY
(DO)
(03) CARDIOLOGY (HEART) PHYSICIAN'S
ASSISTANT (PA)
(04) DERMATOLOGY (SKIN) NURSE PRACTITIONER
(05) ENDOCRINOLOGY/METABOLISM
(DIABETES,THYROID)
(06) FAMILY PRACTICE
(07) GASTROENTEROLOGY
(08) GENERAL PRACTICE
(09) GENERAL SURGERY
(10) GERIATRICS (ELDERLY)
(11) GYNECOLOGY - OBSTETRICS
(12) HEMATOLOGY (BLOOD)
(13) HOSPITAL RESIDENCE
(14) INTERNAL MEDICINE (INTERNIST)
(15) NEPHROLOGY (KIDNEYS)
(16) NEUROLOGY
(17) NUCLEAR MEDICINE
(18) ONCOLOGY (TUMORS, CANCER)
(19) OPHTHALMOLOGY (EYES)
(20) ORTHOPEDICS
(21) OSTEOPATHY (DO)
(22) OTORHINOLARYNGOLOGY (EAR, NOSE,
THROAT)
(23) PAIN MANAGEMENT SPECIALIST
(24) PATHOLOGY
(25) PHYS MED/REHAB
(26) PHYSICIAN’S ASSISTANT
(27) PLASTIC SURGERY
(28) PODIATRIST
(29) PROCTOLOGY
(30) PSYCHIATRY/PSYCHIATRIST
(31) PULMONARY (LUNGS)
(32) RADIOLOGY
(33) RHEUMATOLOGY (ARTHRITIS)
(34) THORACIC SURGERY (CHEST)
(35) UROLOGY
(36) VASCULAR SURGEON/SPECIALIST
(37) AUDIOLOGIST
(38) CHIROPRACTOR
(39) DENTIST
(40) OPTOMETRIST
(41) PHYSICAL THERAPIST
(42) PSYCHOLOGIST
(43) NURSE PRACTITIONER
(91) OTHER DR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED
(01)-(43) BOX USD
(91) US6A - MDSPECOS
(-8) BOX USD
(-9) BOX USD
BOX USD
(01) CONTINUOUS ANSWER
BOX USD
OTHER DR SPECIALTY (SPECIFY)
MDSPECOS
US6A
text
BOX USD
routing
[PROBE FOR RESPONDENT TO SELECT A CHOICE FROM THE CARD IF THEY MENTION A 'GENERIC'
SPECIALITY LIKE ‘HEART DOCTOR.’ IF RESPONDENT ONLY GIVES A 'GENERIC' SPECIALTY AND THE
GENERIC WORD IS SHOWN IN PARENTHESES FOLLOWING ONE OF THE RESPONSES, SELECT THE
RESPONSE CATEGORY FOR THAT SPECIALTY (E.G., 'CARDIOLOGY'). OTHERWISE SELECT 'OTHER DR
SPECIALTY'.]
IF (INTTYPE=7) AND (SAMPLE_PERSON.WHATLANG EQUALS 1-16 OR 91-"Other, Specify"), GO TO LEP1ALANGPREF.
ELSE GO TO BOX US1.
Page 3 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
(01) BOX LEP2
(02) LEP2-LANGPRVD
(03) LEP2-LANGPRVD
(91) LEP1B-LANGPFOS LEP2-LANGPRVD
(-8) LEP2-LANGPRVD
(-9) LEP2-LANGPRVD
LANGPREF
LEP1A
select one
In general, in what language [do you/does (SP)] prefer to receive [your/(SP)'s] medical care?
(01) English
(02) [LANGUAGE SPOKEN AT HOME], or
(03) Both English and [LANGUAGE SPOKEN AT
HOME] equally
(91) OTHER
(-8) Don't Know
(-9) Refused
LANGPFOS
LEP1B
verbatim text
In general, in what language [do you/does (SP)] prefer to receive [your/(SP)'s] medical care?
(01) CONTINUOUS ANSWER
LEP2-LANGPRVD
select one
[Does (US5A PROVIDER NAME) [your/(SP)'s] provider/Do the providers at (US3A PROVIDER NAME)
[your/(SP)'s] usual source of care] speak [LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS [your/(SP)'s]
preferred language]?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) LEP3-LANGCOMM
(02) LEP4-LANGSYMP
(-8) LEP4-LANGSYMP
(-9) LEP4-LANGSYMP
BOX LEP2
(01) VERY WELL
(02) WELL
(03) NOT WELL
(04) NOT AT ALL
(-8) DON’T KNOW
(-9) REFUSED
BOX LEP1
(01) VERY WELL
(02) WELL
(03) NOT WELL
(04) NOT AT ALL
(-8) DON’T KNOW
(-9) REFUSED
BOX LEP2
LANGPRVD
LEP2
SHOW CARD US2
LANGCOMM
LEP3
select one
How well can [you/(SP)] and [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)]
communicate in [LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS] about [your/(SP)'s] symptoms? Very
well, well, not well, or not at all?
BOX LEP1
routing
IF P_ENGWELL=1, GO TO LEP6-LANGPROB. ELSE GO TO BOX US1.
SHOW CARD US2
LANGSYMP
LANGASST
LANGPROB
LEP4
select one
BOX LEP2
routing
IF SP reported that they speak English well, not well, or not at all (P_ENGWELL=1), GO TO LEP6-LANGPROB
LEP5-LANGASST. ELSE GO TO BOX US1.
select all
(01) PROFESSIONAL INTERPRETER
(02) STAFF PERSON AT MEDICAL PROVIDER’S
SHOW CARD US3
OFFICE
(03) FAMILY MEMBER
Who helps [you/(SP)] communicate with [(US5A PROVIDER NAME)/the providers at (US3A PROVIDER NAME)]
(04) FRIEND
– a professional interpreter, a staff person at [your/(SP)'s] provider's office, a family member, a friend, [do
(05) SOMEONE ELSE
you/does (SP)] do the best that [you/(SP)] can in English, or does no one help [you/(SP)] because [you
(06) DOES BEST THAT CAN IN ENGLISH
have/(SP) has] no trouble communicating in English?
(07) NO ONE HELPS; NO TROUBLE
COMMUNICATING IN ENGLISH
PROBE: Anyone else?
(-8) DON’T KNOW
(-9) REFUSED
select one
[Have you/Has (SP)] ever had a problem understanding a medical situation because it was not explained in
[LANGUAGE SPOKEN AT HOME/LEP1B-LANGPFOS [your/(SP)'s] preferred language]?
LEP5
LEP6
Without the aid of a translator, language assistant, or interpreter, how well can [you/(SP)] and [(US5A
PROVIDER NAME)/the providers at (US3A PROVIDER NAME)] communicate in English about [your/(SP)'s]
symptoms? Very well, well, not well, or not at all?
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
LEP6-LANGPROB
LEP7-LANGHELP BOX US1
Page 4 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
LEP7
select all
(01) PROFESSIONAL INTERPRETER
(02) STAFF PERSON AT MEDICAL PROVIDER’S
OFFICE
Now think about all of [your/(SP)'s] medical providers other than [your/(SP)'s] usual provider.
(03) FAMILY MEMBER
(04) FRIEND
Who helps [you/(SP)] communicate with medical providers who do not speak [LANGUAGE SPOKEN AT
(05) SOMEONE ELSE
HOME/LEP1B-LANGPFOS]– a professional interpreter, a staff person at [your/(SP)'s] provider's office, a family (06) DOES BEST THAT CAN IN ENGLISH
member, a friend, [do you/does (SP)] do the best that [you/(SP)] can in English, or does no one help [you/(SP)] (07) DOES NOT SEE A MEDICAL PROVIDER
because [you have/(SP) has] no trouble communicating in English?
(08) NO ONE HELPS; HAS NO TROUBLE
COMMUNICATING IN ENGLISH
PROBE: Anyone else?
(-8) DON’T KNOW
(-9) REFUSED
BOX US1
routing
IF US1 - PLACEPAR = NO, DK, or RF, GO TO US39 - NUSNOTSK.
ELSE IF US2 - PLACEKND = 10/AtHome, GO TO PP1A-PROVYR.
ELSE GO TO US8 - GETUSHOW US9-GETUSUNT.
(01) US9 - GETUSUNT
(02) US9 - GETUSUNT
(03) US9 - GETUSUNT
(04) US9 - GETUSUNT
(05) US9 - GETUSUNT
(06) US9 - GETUSUNT
(07) PP1A-PROVYR
(91) US8 - GETUSOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR
SHOW CARD US3
LANGHELP
BOX US1
GETUSHOW
US8
code one
(01) WALKING
(02) DRIVING
(03) BEING DRIVEN
How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S office/(US3A PROVIDER NAME)]?
(04) AMBULANCE OR OTHER SPECIAL VEHICLE
(05) TAXI
[EXPLAIN IF NECESSARY: [Do you/Does (SP)] get there by walking, driving, being driven by someone else, by (06) OTHER PUBLIC TRANSPORTATION
ambulance or other special vehicle for disabled people, by taxi, other public transportation, or some other way?] (07) DR. USUALLY COMES TO HOME
(91) SOME OTHER WAY
(-8) DON'T KNOW
(-9) REFUSED
GETUSOS
US8
verbatim text
SOME OTHER WAY (SPECIFY)
(01) continuous answer
US9 - GETUSUNT
About how long does it usually take for [you/(SP)] to get there to [[your/their] provider's office/[your/their] usual
source of care]?
(01) HOURS ONLY
(02) MINUTES ONLY
(03) HOURS AND MINUTES
(-8) DON'T KNOW
(-9) REFUSED
(01) US9 - GETUSHRS
(02) US9 - GETUSMIN
(03) US9 - GETUSHRS
(-8) US10 - ACCOMPUS
(-9) US10 - ACCOMPUS
GETUSUNT
US9
code one
GETUSHRS
US9
numeric
HOURS:
(01) CONTINUOUS ANSWER
If US9 GETUSUNT=3/HoursAndMinutes go to US9 GETUSMIN.
Else go to US10 - ACCOMPUS.
GETUSMIN
US9
numeric
MINUTES:
(01) CONTINUOUS ANSWER
US10 - ACCOMPUS
[Do you/Does (SP)] usually have someone accompany [you/(SP)] there?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) US11 - PERSON_USUALGO
(02) PP1A-PROVYR
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR
ACCOMPUS
US10
yes/no
Page 5 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
Who usually goes with [you/(SP)]?
PERSON_USUALGO
US11
USPERGO
code one roster
SELECT OR ADD ONLY ONE PERSON
[PROBE: Is that person a spouse, a child, an other family member, a friend, a home health aide or home care
worker, a homemaker or house cleaner, or some other person?]
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/OtherRelative or 92/OtherNonRelative, display ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(01-N) US11AA-ACCREAS
(N+1) US11_NEW-ROSTFNAM
(01) SPOUSE
(02) CHILD
(03) OTHER FAMILY MEMBER
(04) FRIEND
(05) HOME HEALTH AIDE/HOME CARE WORKER
(91) OTHER
(-8) Don't Know
(-9) Refused
REASACC - REASACC
IF EXISTING PERSON SELECTED, GO TO US11AAACCREAS.
ELSE IF "ADD ANOTHER" SELECTED, GO TO
US11_NEW-ROSTFNAM
ROSTFNAM
US11_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
US11_NEW - ROSTLNAM
ROSTLNAM
US11_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
US11_NEW - ROSTREL
(01) DO NOT DISPLAY
(02) US11AA-ACCREAS
(56) US11AA-ACCREAS
(58) US11AA-ACCREAS
(59) US11AA-ACCREAS
(60) US11AA-ACCREAS
(61) US11AA-ACCREAS
(91) US11_NEW - ROSTREOS
(-8) US11AA-ACCREAS
(-9) US11AA-ACCREAS
US11AA-ACCREAS
ROSTREL
US11_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
US11_NEW
verbatim text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
Page 6 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
What are the reasons [you accompany (SP)/this person accompanies you/this person accompanies (SP) this
person]?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
ACCREAS REASACC US11AA REASACC
code all
[COMMUNICATING WITH THE HEALTHCARE PROVIDER MAY INCLUDE WRITING NOTES, ASKING
QUESTIONS, EXPLAINING MEDICAL CONDITIONS OR NEEDS, OR TRANSLATING LANGUAGE.
PROVIDING LOGISTICAL SUPPORT MAY INCLUDE TRANSPORTATION, SCHEDULING APPOINTMENTS,
PROVIDING PHYSICAL ASSISTANCE.
PROVIDING EMOTIONAL SUPPORT MAY INCLUDE KEEPING THE SP COMPANY OR PROVIDING MORAL
SUPPORT.]
ACCOTHOS
US11AA
verbatim text
OTHER (SPECIFY)
[Have you/Has (SP)] seen [(US5A PROVIDER NAME)/(US3A PROVIDER NAME) [your/their]
provider/[your/their] usual source of care] in the last 12 months?
PROVYR
PP1A
code one
[IF NEEDED: This question is referring to the care provider [you/(SP)] usually saw in the last 12 months.]
Code List
(01) WRITES DOWN WHAT DOCTOR
SAYS/RECORDS INSTRUCTIONS/TAKES
NOTES/REMEMBERS COMMUNICATES WITH
HEALTHCARE PROVIDER
(02) GIVES INFORMATION/EXPLAINS SP'S MEDICAL
CONDITION OR NEEDS TO THE DOCTOR PROVIDES
LOGISTICAL SUPPORT
(03) EXPLAINS DOCTOR’S INSTRUCTIONS TO SP
PROVIDES EMOTIONAL SUPPORT
(04) ASKS QUESTIONS
(05) TRANSLATES LANGUAGE
(06) SCHEDULES APPOINTMENTS
(07) NOTHING/KEEPS SP COMPANY/SITS WITH
SP/MORAL SUPPORT
(08) TRANSPORTATION
(09) SP NEEDS PHYSICAL ASSISTANCE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
Routing
(01) PP1A-PROVYR
(02) PP1A-PROVYR
(03) PP1A-PROVYR
(04) PP1A-PROVYR
(05) PP1A-PROVYR
(06) PP1A-PROVYR
(07) PP1A-PROVYR
(08)PP1A-PROVYR
(09) PP1A-PROVYR
(91) US11AA - ACCOTHOS
(-8) PP1A-PROVYR
(-9) PP1A-PROVYR
PP1A-PROVYR
(01) continuous answer
PP1A-PROVYR
(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED
(01) PP1-REMINDAPPT PP8-DOCHLTH
(02) US27-USCKEVRY US37A-CARESPCL
(-8) US27-USCKEVRY US37A-CARESPCL
(-9) US27-USCKEVRY US37A-CARESPCL
(01) YES
(02) NO
(996) NOT APPLICABLE / R DID NOT HAVE
APPOINTMENT
(-8) DON'T KNOW
(-9) REFUSED
(01) PP2- PREAPPT
(02) PP2- PREAPPT
(996) PP4-MISSAPPT
(-8) PP2- PREAPPT
(-9) PP2- PREAPPT
INCLUDE TELEMEDICINE VISITS.
The next questions ask about the care [you/(SP)] received from [(US5A PROVIDER NAME)'S office/(US3A
PROVIDER NAME)].
REMINDAPPT
PP1
yes/no
Some offices remind patients about appointments. Before [your/(SP)'s] most recent visit with [(US5A
PROVIDER NAME)/(US3A PROVIDER NAME) ], did [you/(SP)] get a reminder from [(US5A PROVIDER
NAME)'S office /(US3A PROVIDER NAME)] about the appointment?
REMINDERS INCLUDE PHONE CALLS, TEXT MESSAGES, E-MAILS, AND MAILED CORRESPONDENCE.
Before [your/(SP)'s] most recent visit with [(US5A PROVIDER NAME)'s office/(US3A PROVIDER NAME)], did
[you/(SP)] get instructions telling [you/(SP)] what to expect or how to prepare?
PREAPPT
PP2
yes/no
(01) YES
(02) NO
INSTRUCTIONS CAN INCLUDE ANYTHING THAT IS NEEDED OR PREPARED BEFORE THE
(-8) DON'T KNOW
APPOINTMENT, SUCH AS PREPARING OR ORGANIZING MEDICAL RECORDS, FASTING, ARRANGING TO (-9) REFUSED
HAVE SOMEONE ACCOMPANY MEDICAL VISIT, ETC.
PP4-MISSAPPT
Page 7 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) PP8-DOCHLTH
(02) PP5- NEWAPPT
(03) PP5-NEWAPPT
(04) PP5- NEWAPPT
(-8) PP8-DOCHLTH
(-9) PP8-DOCHLTH
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP8-DOCHLTH
SHOW CARD US4
MISSAPPT
PP4
code one
Now I’m going to read you questions about the medical providers [you have/SP has] seen in the last twelve
months, that is since {TODAY'S MONTH AND YEAR - 12 MONTHS}.
People have busy lives and miss appointments for many reasons. Since (TODAY'S MONTH AND YEAR-12
MONTHS), how often did [you/(SP)] miss an appointment with [(US5A PROVIDER NAME)/(US3A PROVIDER
NAME)]?
SHOW CARD US4
NEWAPPT
PP5
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [you/(SP)] missed an appointment with US5A
PROVIDER NAME/US3A PROVIDER NAME), how often did someone from [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)] contact [you/(SP)] to make a new appointment?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME) [your/(SP)'s]
(04) ALWAYS
provider/the medical providers at (US3A PROVIDER NAME) [your/(SP)'s] usual source of care] ask about things
(-8) Don't Know
in [your/(SP)'s] work or life at home that affect [your/(SP)'s their] health?
(-9) Refused
PP9- DOCEASY
(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME) [your/(SP)'s]
(04) ALWAYS
provider/the medical providers at (US3A PROVIDER NAME) [your/(SP)'s] usual source of care] explain things in
(-8) Don't Know
a way that was easy [for (SP)] to understand?
(-9) Refused
PP10-DOCLSTN
(01) NEVER
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME) [your/(SP)'s]
(04) ALWAYS
provider/the medical providers at (US3A PROVIDER NAME) [your/(SP)'s] usual source of care] listen carefully to
(-8) Don't Know
[you/(SP)]?
(-9) Refused
PP11-DOCRSPCT PP15-STHLTHGL
SHOW CARD US4 US1
DOCHLTH
PP8
code one
SHOW CARD US4 US1
DOCEASY
PP9
code one
SHOW CARD US4 US1
DOCLSTN
PP10
code one
SHOW CARD US4
DOCRSPCT
PP11
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] show respect for what [you/(SP)] had to say?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP12- ENUFTIME
Page 8 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
SHOW CARD US4
ENUFTIME
PP12
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] spend enough time with [you/(SP)]?
SHOW CARD US4
HLTHIDEA
PP13
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] ask whether [you/(SP)] had ideas about how to improve [your/(SP)'s]
health?
Code List
Routing
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP13- HLTHIDEA
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP15-STHLTHGL
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP16- MTHLTHGL
(02) PP16- MTHLTHGL
(03) US27-USCKEVRY
(-8) US27-USCKEVRY
(-9) US27-USCKEVRY
US37A - CARESPCL
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
US27-USCKEVRY
SHOW CARD US5 US2
STHLTHGL
PP15
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME) [your/(SP)'s] provider/the
medical providers at (US3A PROVIDER NAME) [your/(SP)'s] usual source of care]] talk with [you/(SP)] about
setting goals for [your/(SP) their] health?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US5
MTHLTHGL
PP16
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did the care [you/(SP)] received from [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)] help [you/(SP)] meet [your/(SP)'s] goals?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US6
USCKEVRY
USUNWRNG
US27
US27
list
(01) STRONGLY AGREE
(02) AGREE
Think about the care [you receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For (03) DISAGREE
each statement, please tell me whether you strongly agree, agree, disagree, or strongly disagree.
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
[(US5A PROVIDER NAME) is/The doctors or other health professionals at (US3A PROVIDER NAME) are] very (-8) Don't Know
careful to check everything when examining [you/(SP)].
(-9) Refused
US27-USUNWRNG
list
(01) STRONGLY AGREE
(02) AGREE
SHOW CARD US6
(03) DISAGREE
(04) STRONGLY DISAGREE
[(US5A PROVIDER NAME) has/The doctors or other health professionals at (US3A PROVIDER NAME) have] a
(05) NOT APPLICABLE
complete understanding of the things that are wrong with [you/(SP)].
(-8) Don't Know
(-9) Refused
BOX US4
Page 9 of 20
2026 MCBS Community Questionnaire
Variable Name
USQ-USUAL SOURCE OF CARE
MR Screen Name
Question Type
Question Text/Description
Code List
Routing
BOX US4
routing
IF PP1A-PROVYR= 01/YES, GO TO PP17 OTHRSTFF.
ELSE GO TO BOX US5.
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) OSUPTDAT
(02) ORDRTEST
(-8) ORDRTEST
(-9) ORDRTEST
grid
Did these other staff seem up-to-date about the care [you were/(SP) was] receiving from [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)]?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
OSTALKCR
grid
Did these other staff talk with [you/(SP)] about care [you/he/she] [were/was] receiving from [(US5A PROVIDER
NAME)/the medical providers at (US3A PROVIDER NAME)]?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
OSKNWINF
Did these other staff seem to know the important information about [your/(SP)'s] medical history?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
PP21- ORDRTEST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP22- TSTFLWUP
(02) PP29-HLTHSRVC
(-8) PP29-HLTHSRVC
(-9) PP29-HLTHSRVC
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
PP23-RQSTRSLT
People often get instructions about their health from more than one person in the same office, such as other
medical providers, nurses, nutritionists, and social workers.
OTHRSTFF
PP17
yes/no
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get any instructions about your health from
any other staff [in (US5A PROVIDER NAME)'s office/ at (US3A PROVIDER NAME)]?
OSUPTDAT
OSTALKCR
OSKNWINF
PP18
PP18
PP1820
grid
The next set of questions ask about the care [you/(SP)] received from [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)].
ORDRTEST
PP21
yes/no
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] order a blood test, x-ray, or other test for [you/(SP)]?
SHOW CARD US4
TSTFLWUP
PP22
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), when [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] ordered a blood test, x-ray, or other test for [you/(SP)], how often did [(US5A
PROVIDER NAME)/the medical providers at (US3A PROVIDER NAME)] follow up to give [you/(SP)] those
results?
Page 10 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP24- RSLTEASY
code one
(01) NEVER
SHOW CARD US4
(02) SOMETIMES
(03) USUALLY
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often were [your/(SP)'s] test results presented in a way (04) ALWAYS
that was easy to understand?
(-8) Don't Know
(-9) Refused
PP29-HLTHSRVC
yes/no
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need services at home to help [you/(SP)]
take care of [your/(SP)'s] health?
SHOW CARD US4
RQSTRSLT
RSLTEASY
HLTHSRVC
PP23
PP24
PP29
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [you/(SP)] have to request [your/(SP)'s] test
results before [you/(SP)] got them?
SHOW CARD US4
SRVCHELP
GIVEINST
PP30
PP31
code one
yes/no
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] help [you/(SP)] get these services at home to take care of [your/(SP)'s]
health?
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [(US5A PROVIDER NAME)/the medical providers at
(US3A PROVIDER NAME)] give [you/(SP)] instructions about how to take care of [your/(SP)'s] health?
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] take any prescription medicine?
ANYRX
PP35
yes/no
[THIS IS DIFFERENT FROM THE PRESCRIPTION DRUG WHERE WE ASK IF THE R HAD ANY
PRESCRIPTIONS FILLED]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP30- SRVCHELP
(02) PP31- GIVEINST
(-8) PP31- GIVEINST
(-9) PP31- GIVEINST
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP31- GIVEINST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
PP35-ANYRX
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP36- TALKRX
(02) BOX US5
(-8) BOX US5
(-9) BOX US5
Page 11 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
SHOW CARD US4
TALKRX
PP36
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] talk with [you/(SP)] about how [you were/(SP) was] supposed to take
[your/(SP)'s] medicine?
SHOW CARD US4
ASPRSCBD
PP37
code one
There are many reasons why people may not always be able to take their medicines as prescribed.
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often [were you/was (SP)] able to take [your/(SP)'s]
medicine as prescribed?
SHOW CARD US4
BADRCTN
PP38
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), how often did [(US5A PROVIDER NAME)/the medical
providers at (US3A PROVIDER NAME)] talk with [you/(SP)] about what to do if [you have/(SP) has] a bad
reaction to [your/(SP)'s] medicine?
BOX US5
routing
GO TO US37A - CARESPCL.
Code List
Routing
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP37- ASPRSCBD
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP38-BADRCTN
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
BOX US5
SHOW CARD US1 US3
CARESPCL
US37A
yes/no
Specialists are doctors or other health professionals who specialize in one area of health care. This card lists
some examples of specialists.
(01) YES
(02) NO
(-8) DON'T KNOW
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] receive care from any specialists outside the (-9) REFUSED
office of [(US5A PROVIDER NAME) [your/(SP)'s] provider/the doctors or other health professionals at (US3A
PROVIDER NAME) [your/(SP)'s] usual source of care]]?
SHOW CARD US4 US1
DRINFRMD
US37B
code one
In general, how often [does (US5A PROVIDER NAME) [your/(SP)'s] provider/do the doctors or other health
professionals at (US3A PROVIDER NAME) [your/(SP)'s] usual source of care] seem informed and up-to-date
about the care [you get/(SP) gets] from specialists?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) US37B - DRINFRMD
(02) PP50-HOSADMIT
(-8) PP50-HOSADMIT
(-9) PP50-HOSADMIT
US37C - REMINDDR PP50-HOSADMIT
Page 12 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
SHOW CARD US4
REMINDDR
STPMSPCL
US37C
US37D
code one
yes/no
In general, how often [do you/does(SP)] have to remind [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] about care [you receive/(SP) receives] from specialists?
US37E
code one
In general, how often [does (US5A PROVIDER NAME)/do the doctors or other health professionals at (US3A
PROVIDER NAME)] talk with [you/(SP)] about the medicines prescribed by these specialists?
The next four questions ask about care [you/(SP)] received from the specialist [you/(SP)] saw most often in the
last 12 months outside the office of [(US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME)].
NAMESPCL
US37E1
verbatim text
First, what is the name of the specialist [you/(SP)] saw most often since (TODAY'S MONTH AND YEAR-12
MONTHS)?
[ENCOURAGE THE RESPONDENT TO REFER TO A BILL, TELEPHONE DIRECTORY, APPOINTMENT
CARD, ETC., FOR COMPLETE INFORMATION.]
SEXSPCL
US37E2
code one
Routing
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
US37D - STPMSPCL
(01) YES
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did any specialists outside the office of [(US5A PROVIDER
(02) NO
NAME)/the doctors or other health professionals at (US3A PROVIDER NAME)] prescribe medicine for
(-8) DON'T KNOW
[you/(SP)]?
(-9) REFUSED
SHOW CARD US4
TALKPMS
Code List
Is [(US37E1 PROVIDER NAME)/the specialist you saw most often since (TODAY'S MONTH AND YEAR-12
MONTHS)] a male or female?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
(01) US37E - TALKPMS
(02) US37E1 - NAMESPCL
(-8) US37E1 - NAMESPCL
(-9) US37E1 - NAMESPCL
US37E1 - NAMESPCL
[DISPLAY PROVIDER ROSTER AS RESPONSE
OPTIONS:
1. [PROVIDER 1]
2. [PROVIDER 2]
(01) continuous answer
(-8) Don't Know
(-9) Refused
US37E2 - SEXSPCL
DISPLAY PROVIDER NAME, SPECIALITY, GROUP
NAME FOR ALL PROVIDERS WHERE PROVNUM>02
(01) MALE
(02) FEMALE
(-8) DON’T KNOW
(-9) REFUSED
US37F - KNOWSPCL
Page 13 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) Don't Know
(-9) Refused
US37G - RPTINFO
SHOW CARD US5
[IF NEEDED: This question is about the last twelve months, that is since (TODAY'S MONTH AND YEAR - 12
MONTHS).]
KNOWSPCL
US37F
code one
The next questions ask about care [you/(SP)] received from the specialist [you/(SP)] saw most often in the last
twelve months outside the [office of (US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME)].
When [you see/(SP) sees/(SP) sees] [(US37E1-SPCLNAME)/this specialist], does [he/she/he or she] seem to
know enough information about [your/(SP)'s] medical history?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US4
RPTINFO
US37G
code one
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often [do you/does (SP)] have to repeat
information that [you/(SP)] [have/has] already given to [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)]?
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
KNOWRSLT
SHOW CARD US4
KNOWRSLT
PP49
(01) NEVER
(02) SOMETIMES
(03) USUALLY
(04) ALWAYS
(-8) Don't Know
(-9) Refused
PP50-HOSADMIT
yes/no
Since (TODAY'S MONTH AND YEAR-12 MONTHS), [were you/was (SP)] admitted to a hospital overnight or
longer?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP51- HOSFLWUP PP56- HOSINFO
(02) PP58- MNGCARE PP58A-DOCCARE
(-8) PP58- MNGCARE PP58A-DOCCARE
(-9) PP58- MNGCARE PP58A-DOCCARE
yes/no
After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] contact [you/(SP)] to see how [you were/(SP) was] doing?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
PP52- HOSMED
After [your/(SP)'S] most recent hospital stay, [were you/was (SP)] prescribed any medicines?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP53- HOSFOLLOWUP
(02) PP54- HOSINSTU
(-8) PP54- HOSINSTU
(-9) PP54- HOSINSTU
code one
The next questions ask about care [you/(SP)] received from the specialist [you/(SP)] saw most often since
(TODAY'S MONTH AND YEAR-12 MONTHS) outside the [office of (US5A PROVIDER NAME)/the doctors or
other health professionals at (US3A PROVIDER NAME)].
When [you see/(SP) sees] [(US37E1-SPCLNAME)/this specialist], how often does [he/she/he or she] seem to
know [your/(SP)'s] important test results from other providers?
HOSADMIT
HOSFLWUP
HOSMED
PP50
PP51
PP52
yes/no
Page 14 of 20
2026 MCBS Community Questionnaire
Variable Name
HOSFOLLOWUP
HOSINSTU
MR Screen Name
PP53
PP54
USQ-USUAL SOURCE OF CARE
Question Type
Question Text/Description
Code List
Routing
yes/no
After (your/(SP)'s)] most recent hospital stay, did [(US5A PROVIDER NAME)/the medical providers at (US3A
PROVIDER NAME)] contact [you/SP] to check if [you were/(SP) was] able to follow instructions about any
medicines [you were/(SP) was] prescribed?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
PP54- HOSINSTU
yes/no
After (your/(SP)'s] most recent hospital stay, (were you/was (SP)] given instructions about caring for
[yourself/themself] at home?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PP55- INSTUEASY
(02) PP56- HOSINFO
(-8) PP56- HOSINFO
(-9) PP56- HOSINFO
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
PP56- HOSINFO
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
PP58-MNGCARE PP58A-DOCCARE
SHOW CARD US5
INSTUEASY
PP55
code one
After [your/(SP)'s] most recent hospital stay, were the instructions [you were/(SP) was] given easy to
understand?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
SHOW CARD US5 US2
HOSINFO
PP56
code one
After [your/(SP)'s] most recent hospital stay, did [(US5A PROVIDER NAME) [your/(SP)'s] provider/the medical
providers at (US3A PROVIDER NAME) [your/(SP)'s] usual source of care] seem to know the important
information about this hospital stay?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
code one
(00) 0 HARD TO MANAGE
(01) 1
(02) 2
People sometimes need to manage their medical care by making appointments with multiple providers, following
(03) 3
their instructions, and taking medicines as prescribed.
(04) 4
(05) 5
Using any number from 0 to 10, where 0 is hard and 10 is easy, what number would you use to rate how easy it
(06) 6
was for [you/(SP)] to manage [your/(SP)'s] medical care since (TODAY'S MONTH AND YEAR-12 MONTHS)?
(07) 7
(08) 8
[IN SITUATIONS WHERE A PROXY OR SOMEONE ELSE MANAGES THE RESPONDENT’S MEDICAL CARE
(09) 9
FOR OR WITH THEM, ANSWER BASED ON THEIR EXPERIENCE.]
(10) 10 EASY TO MANAGE
PP58A-DOCCARE
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] need help from [anyone in (US5A
PROVIDER NAME)'s [your/their] provider's office/the doctors or other health professionals at (US3A PROVIDER
NAME) [your/their] usual source of care] to manage [your/(SP)'s their] care among these different providers and
services?
(01) PP58B-GETHELP
(02) PP59-ONEDOC
(-8) PP59-ONEDOC
(-9) PP59-ONEDOC
SHOW CARD US7
MNGCARE
DOCCARE
PP58
PP58A
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Page 15 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
SHOW CARD US5 US2
GETHELP
PP58B
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), did [you/(SP)] get the help [you/(SP) they] needed from
[(US5A PROVIDER NAME)'s [your/their] provider's office/the doctors or other health professionals at (US3A
PROVIDER NAME) [your/their] usual source of care] to manage [your/(SP)'s their] care among these different
providers and services?
SHOW CARD US5 US2
ONEDOC
PP59
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider who knew about all [your/(SP)'s]
medical care needs?
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
Code List
Routing
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
PP59-ONEDOC
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
PP60- PRVNOMED
(01) YES, DEFINITELY
(02) YES, SOMEWHAT
(03) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX US7 BOX USEND
(01) YES
(02) NO
(03) NOT APPLICABLE
(04) NOT SURE
(-9) Refused
BOX EHR1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) US37K - EMEDREC
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD
SHOW CARD US5 US2
Since (TODAY'S MONTH AND YEAR-12 MONTHS), was there one provider who knew about all the medicines
[you were/(SP) was] taking?
PRVNOMED
PP60
code one
[IF YES, THEN PROBE: Would you say definitely yes or somewhat yes?]
IF THE RESPONDENT WAS NOT TAKING ANY MEDICINES, PROBE IF THERE WAS ONE PROVIDER WHO
KNEW THAT.
BOX US7
NOTAVAIL
COMPUSE
routing
GO TO US37I- NOTAVAIL
US37I
code one
Since (TODAY'S MONTH AND YEAR-12 MONTHS), when getting care for a medical problem, was there ever a
time when test results, medical records, or reasons for referrals were not available at the time of [your/(SP)’s]
scheduled doctor or other health professional appointment?
BOX EHR1
routing
IF US1-PLACEPAR=1, GO TO EHR2-COMPUSE,
ELSE GO TO BOX USEND.
EHR2
yes/no
The next few questions will help us understand how [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] use(s) a computer during [your/(SP)'s] office visit. Please answer
the following questions based on where [you go/(SP) goes] for medical care most of the time.
[Does (US5A PROVIDER NAME)/Do the providers at (US3A PROVIDER NAME)] use a computer during
[your/(SP)'s] office visit?
Page 16 of 20
2026 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
USQ-USUAL SOURCE OF CARE
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) EHR3-COMPSHW
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD
yes/no
Is the examination room set up so that [(US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME)] can easily show [you/(SP)] information on the computer screen?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) EHR4-COMPINFO
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD
yes/no
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)]
use the computer to show [you your/(SP) their] health information during [your/(SP)'s] visit, such as trends in
blood pressure reading, height, weight and body mass index, previous lab results, x-rays/images, immunizations
or medications?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) EHR5-COMPREC
(02) EHR6-COMPRD
(-8) EHR6-COMPRD
(-9) EHR6-COMPRD
yes/no
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)]
use the computer to show [you/(SP)] recommendations for preventive health screenings or other medical
services?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
EHR6-COMPRD
yes/no
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)]
read back to [you/(SP)] information that [you have/(SP) has] given during [your/(SP)'s] visit that is being put into
[your/(SP)'s] medical record?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
EHR7-COMPINF
yes/no
[Does (US5A PROVIDER NAME)/Do the doctors or other health professionals at (US3A PROVIDER NAME)]
send [you/(SP)] health information electronically, such as information about [your/(SP)'s] medications, exercise
plans, dietary advice, etc.?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
EHR8-COMPACC
Many health care providers are beginning to use electronic or computer-based medical records instead of using
paper-based records. When [you visit/(SP) visits] [(US5A PROVIDER NAME)/the doctors or other health
professionals at (US3A PROVIDER NAME)] [does he or she/do they] generally enter [your/(SP)'s] health
information into a computer while [you are/(SP) is] present?
EMEDREC
US37K
yes/no
[IF SUPPORT STAFF (NURSES, MEDICAL ASSISTANTS) ENTER INFORMATION INTO THE ELECTRONIC
HEALTH RECORD DURING THEIR VISIT, SELECT “YES” AT THIS QUESTION.]
[EXPLAIN IF NECESSARY: An “electronic health record” is an electronic version of a patient’s medical history
maintained by a provider over time. It automates the way in which doctors can access patient health information.
"Health Information" includes information such as symptoms, vital signs, test results, or prescribed medicines.]
COMPSHW
COMPINFO
COMPREC
COMPRD
COMPINF
EHR3
EHR4
EHR5
EHR6
EHR7
Page 17 of 20
2026 MCBS Community Questionnaire
Variable Name
COMPACC
MR Screen Name
USQ-USUAL SOURCE OF CARE
Question Type
Question Text/Description
Code List
Routing
EHR8
yes/no
[Does (US5A PROVIDER NAME)'s/Do the doctors or other health professionals at (US3A PROVIDER NAME)'s]
office give [you/(SP)] access through [your/(SP)'s] own computer or smart phone to parts or all of [your/(SP)'s]
electronic medical record (such as a list of [your/(SP)'s] medications, lab results, x-ray reports, office notes)
through a “patient portal” or other electronic system?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX EHR2
BOX EHR2
routing
IF EHR2-COMPUSE=(01) YES, GO TO EHR9-COMPHLP,
ELSE GO TO BOX USEND
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
EHR9-COMPDIST
(01) STRONGLY AGREE
(02) AGREE
(03) DISAGREE
(04) STRONGLY DISAGREE
(05) NOT APPLICABLE
(-8) Don't Know
(-9) Refused
EHR9-COMPATT
(01) STRONGLY AGREE
(02) AGREE
SHOW CARD US6
(03) DISAGREE
(04) STRONGLY DISAGREE
[(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME)] use of the
(05) NOT APPLICABLE
computer during [my/(SP)'s] visit distracts [me/(SP)] from paying attention to the clinician.
(-8) Don't Know
(-9) Refused
EHR10-COMPTM
SHOW CARD US6
COMPHLP
EHR9
list
Now I am going to read some statements people have made about how their provider uses a computer. Think
about the care [you receive/(SP) receives] from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each
statement, please tell me whether you strongly agree, agree, disagree, or strongly disagree.
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME) use of the
computer during [my/(SP)'s] visit is helpful to [me/(SP)].
SHOW CARD US6
COMPDIST
COMPATT
EHR9
EHR9
list
list
(US5A PROVIDER NAME)'s/The doctors or other health professionals at (US3A PROVIDER NAME) use of the
computer during [my/(SP)'s] visit distracts [him/her/them] from paying attention to [me/(SP)].
SHOW CARD US8
COMPTM
EHR10
code one
For the next statement, please tell me if it's much more than it should be, somewhat more than it should be,
about what it should be, somewhat less than it should be, much less than it should be, or no opinion?
The amount of time during the visit that (US5A PROVIDER NAME)/the doctors or other health professionals at
(US3A PROVIDER NAME) spend(s) on the computer seems:
(01) Much more than it should be
(02) Somewhat more than it should be
(03) About what it should be
(04) Somewhat less than it should be
(05) Much less than it should be
(06) No opinion
BOX USEND
Page 18 of 20
2026 MCBS Community Questionnaire
Variable Name
NUSNOTSK
NUSMOVIN
NUSAVAIL
MR Screen Name
US39
US39
US39
USQ-USUAL SOURCE OF CARE
Question Type
Question Text/Description
Code List
list
I am going to read some reasons that people have given for not having a usual source of health care. For each
(01) YES
one, please tell me whether or not it is a reason [you do/(SP) does] not have a usual place for health care.
(02) NO
(-8) DON'T KNOW
There is no reason to have a usual source of health care because [you/(SP)] seldom or never [get/gets] sick. [Is
(-9) REFUSED
that a reason [you do/(SP) does] not have a usual source of health care?]
list
[You/(SP)] recently moved into the area. [Is that a reason [you do/(SP) does] not have a usual source of health
care?]
list
(01) YES
[Your/(SP’s)] usual source of health care in this area is no longer available. [Is that a reason [you do/(SP) does] (02) NO
not have a usual source of health care?]
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
USWHYNAV
US42
code one
Why is [your/(SP’s)] usual source of health care no longer available?
(01) PREVIOUS DOCTOR RETIRED
(02) PREVIOUS DOCTOR DIED
(03) PREVIOUS DOCTOR MOVED
(04) SP MOVED
(05) PREVIOUS DR/PLACE TOO FAR AWAY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
USWHYNO1
US42
verbatim text
OTHER (SPECIFY)
(01) CONTINUOUS ANSWER
Routing
US39 - NUSMOVIN
US39 - NUSAVAIL
(01) US42 - USWHYNAV
(02) US43 - NUSDIFFP
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
US43 - NUSDIFFP
(01) US43 - NUSDIFFP
(02) US43 - NUSDIFFP
(03) US43 - NUSDIFFP
(04) US43 - NUSDIFFP
(05) US43 - NUSDIFFP
(91) US42 - USWHYNO1
(-8) US43 - NUSDIFFP
(-9) US43 - NUSDIFFP
US43 - NUSDIFFP
Thinking about other possible reasons that people have for not having a usual source of health care, please tell
me if this statement applies to [you/(SP)]:
NUSDIFFP
NUSTOOFR
US43
US43
list
(01) YES
(02) NO
(-8) DON'T KNOW
[You like/(SP) likes] to go to different places for different health care needs. [Is that a reason [you do/(SP) does]
(-9) REFUSED
not have a usual source of health care?]
US43 - NUSTOOFR
list
The places where [you/(SP)] can receive health care are too far away. [Is that a reason [you do/(SP) does] not
have a usual source of health care?]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
US43 - NUSTOOEX
Page 19 of 20
2026 MCBS Community Questionnaire
Variable Name
NUSTOOEX
MR Screen Name
USQ-USUAL SOURCE OF CARE
Question Type
Question Text/Description
Code List
US43
list
(01) YES
The cost of health care is too expensive. [Is that a reason [you do/(SP) does] not have a usual source of health (02) NO
care?]
(-8) DON'T KNOW
(-9) REFUSED
BOX USEND
routing
GO TO TLQ
Routing
BOX USEND
Page 20 of 20
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2025:09:30 13:16:58-05:00 |
| File Created | 2025:09:30 12:34:52-05:00 |