MEPS supporting statement v17

MEPS supporting statement v17.doc

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

Document [pdf]

Download: pdf | pdf

Beta

Prescribed Medicines (PM) Section

PM01

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

The next questions are about prescription medicines (PERSON) purchased or

received {since (START DATE)/between (START DATE) and (END DATE)}.

[It would be very helpful for the following questions if we could look at the

bottles, containers, tubes, or bags for each of the medicines we will be talking

about.]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

DISPLAY INSTRUCTIONS:

DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.

DISPLAY ‘between (START DATE) and (END DATE)’ IF ROUND 5.

PROGRAMMER NOTES:

MEDICINES ARE FLAGGED AS ‘CREATED’ ONLY ONCE (I.E., THE ROUND

IN WHICH THE MEDICINE IS INITIALLY REPORTED). MEDICINES ARE

FLAGGED AS ‘SELECTED’ WHEN CHOSEN IN SUBSEQUENT ROUNDS. THUS,

FOR ONE ROUND, A MEDICINE CAN ONLY BE FLAGGED AS EITHER

‘CREATED’ OR ‘SELECTED’, BUT NOT BOTH.

ROUTING INSTRUCTION:

IF PERSON HAS NO MEDICINES CREATED OR SELECTED ON PERSON'S-

PRESCRIBED-MEDICINES-ROSTER DURING THE CURRENT ROUND, GO TO

PM04.

OTHERWISE, CONTINUE WITH PM02.

Beta

Prescribed Medicines (PM) Section

PM02

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

While we were talking about (PERSON)'s medical care, we listed the following

prescription(s) as purchased or received {since (START DATE)/between

(START DATE) and (END DATE)}. (READ MEDICINES BELOW.)

{NAME OF PRESCRIPTION MEDICINE}

Size

Variable Name

Label

PRND.WRNGMEDS

COUNTER FOR INCORRECT MEDICINES

INFORMATION OKAY

{PM04}

AT LEAST ONE MEDICINE INCORRECT

DISPLAY INSTRUCTIONS:

DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.

DISPLAY ‘between (START DATE) and (END DATE)’ IF ROUND 5.

ROUTING INSTRUCTION:

IF CODED ‘2’ (AT LEAST ONE MEDICINE INCORRECT) AND THERE IS

ONLY ONE MEDICINE ON PERSON’S-PRESCRIBED-MEDICINES-ROSTER,

SELECT THAT MEDICINE AUTOMATICALLY BY CAPI AT PM03 AND GO TO

PM04.

IF CODED ‘2’ (AT LEAST ONE MEDICINE INCORRECT) AND THERE IS

MORE THAN ONE MEDICINE ON PERSON’S-PRESCRIBED-MEDICINES-

ROSTER, CONTINUE WITH PM03.

Title:

PERSON'S_PRESCRIBED-MEDICINES_1

Roster Details

Col #

Header

Instructions

PRESCRIBED

MEDICINE

Display name of prescribed medicine

PMED.PMEDNAME

Beta

Prescribed Medicines (PM) Section

Roster Behavior:

1. Display only.

2. Select, add, delete, and edit disallowed.

Roster Filter:

Display only those prescribed medicines that are flagged as

either 'created' or 'selected' during the current round.

Roster Definition:

This item displays the PERSON'S-PRESCRIBED-MEDICINES-ROSTER

for display.

Beta

Prescribed Medicines (PM) Section

PM03

SELECT MEDICINE(S) THAT WERE RECORDED INCORRECTLY.

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Size

Variable Name

Label

PRND.WRNGMEDS

COUNTER FOR INCORRECT MEDICINES

[1. Prescribed Medicine]

[2. Prescribed Medicine]

[3. Prescribed Medicine]

{PM04}

PROGRAMMER NOTES:

FLAG SELECTED MEDICINES AS 'INCORRECT'. THESE MEDICINES WILL

NOT BE ELIGIBLE FOR LOOP_01 (I.E., NOT 'CREATED' OR 'SELECTED'

THIS ROUND).

Title:

PERSON'S_PRESCRIBED-MEDICINES_1

Roster Details

Col #

Header

Instructions

PRESCRIBED

MEDICINE

Display name of prescribed medicine

PMED.PMEDNAME

Roster Behavior:

1. Multiple select allowed.

2. Add, delete, and edit disallowed.

Roster Definition:

This item displays the PERSON'S-PRESCRIBED-MEDICINES-ROSTER

for selection.

Beta

Prescribed Medicines (PM) Section

PM04

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(PM04Help)

{Since (START DATE)/Between (START DATE) and (END DATE)},

(have/has) (PERSON) obtained any medicines [we have not yet talked about]?

For example, (have/has) (PERSON) had any new prescriptions or a refill of a

prescription?

Please include any on-line prescriptions.

Size

Variable Name

Label

PRND.NEWMEDS

HAS PERSON GOTTEN NEW MEDICINES

YES

{PM05}

{PM06}

Refused

{PM06}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM06}

HELP AVAILABLE FOR DEFINITION OF PRESCRIPTIONS AND REFILLS.

DISPLAY INSTRUCTIONS:

DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5.

DISPLAY ‘Between (START DATE) and (END DATE)’ IF ROUND 5.

Beta

Prescribed Medicines (PM) Section

PM05

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What were the names of these medicines?

PROBE: Any other medicines?

Size

Variable Name

Label

PMED.PMEDID

PMED ID KEY: PERSID + COUNTER(3) + CD

PMED.PMEDRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PMED.CREATEQ

QUESTION THAT CREATED PMED SEGMENT

PMED.PMEDNAME

NAME OF MEDS AND PRESCRIPTIONS FILLED

PMED.DRUGLINK

LINKS PMED TO DRUGID

EVNT.EVNTID

EVNT ID KEY: PERSID + COUNTER(3) + CD

EVNT.EVNTRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

EVNT.CREATEQ

QUESTION THAT CREATED EVNT SEGMENT

EVNT.EVNTTYPE

EVENT TYPE

EVPV.EVPVID

EVPV ID KEY: EVNTID + PROVID

EVPV.EVPVRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

EVPV.CREATEQ

QUESTION THAT CREATED EVPV SEGMENT

EVPV.EVNTTYPE

EVENT TYPE

EVPV.EVPVTYPE

PROVIDER TYPE RELATED TO EVENT

DRUG.DRUGID

DRUG ID KEY: PERSID + COUNTER(3)

DRUG.DRUGRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

DRUG.CREATEQ

QUESTION THAT CREATED DRUG SEGMENT

DRUG.DRUGNAME

NAME OF MEDS AND PRESCRIPTIONS FILLED

[Prescribed Medicine]

{PM06}

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Prescribed Medicines (PM) Section

PROGRAMMER NOTES:

FLAG ANY MEDICINE ADDED TO THE ROSTER AS 'CREATED' IN THIS

ROUND.

FLAG ANY MEDICINE SELECTED FROM THE ROSTER AS 'SELECTED' IN

THIS ROUND, IF THIS IS THE FIRST TIME THAT THE MEDICINE IS

SELECTED IN CAPI IN THIS ROUND. FOR ANY ONE ROUND, A MEDICINE

CAN BE FLAGGED ONLY AS 'CREATED' OR 'SELECTED', BUT NOT BOTH

IN THAT SAME ROUND.

AT THIS ITEM, THE ROSTER WILL DISPLAY ALL MEDICINES IN

PERSON'S-PRESCRIBED-MEDICINES-ROSTER. THAT DISPLAY WILL

INCLUDE ALL MEDICINES CREATED IN PREVIOUS ROUNDS AND IN THE

CURRENT ROUND. WHEN A MEDICINE CREATED IN A PREVIOUS ROUND IS

SELECTED, CREATE A NEW EVENT FOR THAT MEDICINE. FOR SUCH

MEDICINES, (AND FOR ADDED MEDICINES), CAPI WILL ASK THE CP

SECTION AND THE PHARMACY OF THE PURCHASE.

ANY MEDICINE ADDED TO THE ROSTER SHOULD BE FLAGGED AS

‘CREATED’ THIS ROUND (WITH THE ROUND STATUS). ANY MEDICINE

SELECTED AT THE ROSTER SHOULD BE FLAGGED AS ‘SELECTED’ THIS

ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT

EACH PERSON’S-PRESCRIBED- MEDICINES-ROSTER THROUGHOUT THE

INSTRUMENT (UNLESS OTHERWISE SPECIFIED), THE FIRST TIME THE

MEDICINE IS ADDED OR SELECTED DURING THE ROUND. FOR EXAMPLE,

IF IT IS ROUND 1, ALL MEDICINES ON THE ROSTER WOULD HAVE THE

FLAG ‘CREATED - ROUND 1’. IF A MEDICINE IS CREATED IN HS, BUT

SELECTED IN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE

FLAG ‘CREATED - ROUND 1’. THUS, FOR ANY ONE ROUND, A MEDICINE

CAN ONLY BE FLAGGED AS ‘CREATED’ OR ‘SELECTED’. IF IT IS

ROUND 2 AND A MEDICINE THAT WAS CREATED IN ROUND 1 IS

SELECTED, IT SHOULD BE FLAGGED AS ‘SELECTED - ROUND 2’. THIS

FLAG IS IN ADDITION TO THE ORIGINAL ‘CREATED - ROUND 1’ FLAG.

WHEN A MEDICINE FROM A PREVIOUS ROUND IS SELECTED, CREATE A

NEW EVENT SINCE IT INVOLVES A NEW PURCHASE. A NEW PURCHASE

REQUIRES ASKING THE CHARGE/PAYMENT (CP) SECTION AND PHARMACY

OF THE PURCHASE. THE REASON FOR INCLUDING ALL OF THE

PRESCRIBED MEDICINES ON THE ROSTER IS SIMPLY TO AVOID THE

INTERVIEWER HAVING TO TYPE THEM IN AGAIN (IF THE PERSON IS

GETTING REFILLS OF THE SAME MEDICINE EVERY ROUND).

Title:

PERSON'S_PRESCRIBED-MEDICINES_1

Roster Details

Col #

Header

Instructions

PRESCRIBED

MEDICINE

Display name of prescribed medicine

PMED.PMEDNAME

Roster Behavior:

Roster Definition:

This item displays the PERSON’S-PRESCRIBED-MEDICINES-ROSTER

for selection/addition.

Beta

Prescribed Medicines (PM) Section

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a PMED

added on this screen as long as CAPI has not yet created the

link between this PMED and the EVNT. If delete is attempted

at a time when it is not allowed, display the following error

message: ‘DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.’

4. Limited edit allowed. Interviewer may edit the name of a

PMED added on this screen as long as CAPI has not yet created

the link between this PMED and the EVNT. If edit is attempted

at a time when it is not allowed, display the following error

message: ‘EDIT ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.’

Roster Filter:

Display all; no filter.

PM06

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(PM06Help)

{Since (START DATE)/Between (START DATE) and (END DATE)}, did

(PERSON) get any free samples of prescribed medicines from a medical or

dental provider that we have not yet talked about?

Size

Variable Name

Label

PRND.FREESAMP

HAS PERSON RECEIVED FREE SAMPLES OF MEDS

YES

{PM07}

{BOX_01}

Refused

{BOX_01}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_01}

HELP AVAILABLE FOR DEFINITION OF FREE SAMPLES.

DISPLAY INSTRUCTIONS:

DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5.

DISPLAY ‘Between (START DATE) and (END DATE)’ IF ROUND 5.

Beta

Prescribed Medicines (PM) Section

PM07

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What are the names of the medicines (PERSON) got as free samples?

PROBE: Any other free samples?

Size

Variable Name

Label

PMED.PMEDID

PMED ID KEY: PERSID + COUNTER(3) + CD

PMED.PMEDRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PMED.CREATEQ

QUESTION THAT CREATED PMED SEGMENT

PMED.PMEDNAME

NAME OF MEDS AND PRESCRIPTIONS FILLED

PMED.FRSAMPLE

MEDICINE PERSON GOT AS FREE SAMPLES

PMED.DRUGLINK

LINKS PMED TO DRUGID

EVNT.EVNTID

EVNT ID KEY: PERSID + COUNTER(3) + CD

EVNT.EVNTRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

EVNT.CREATEQ

QUESTION THAT CREATED EVNT SEGMENT

EVNT.EVNTTYPE

EVENT TYPE

EVPV.EVPVID

EVPV ID KEY: EVNTID + PROVID

EVPV.EVPVRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

EVPV.CREATEQ

QUESTION THAT CREATED EVPV SEGMENT

EVPV.EVNTTYPE

EVENT TYPE

EVPV.EVPVTYPE

PROVIDER TYPE RELATED TO EVENT

DRUG.DRUGID

DRUG ID KEY: PERSID + COUNTER(3)

DRUG.DRUGRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

DRUG.CREATEQ

QUESTION THAT CREATED DRUG SEGMENT

DRUG.DRUGNAME

NAME OF MEDS AND PRESCRIPTIONS FILLED

[Prescribed Medicine]

{BOX_01}

PROGRAMMER NOTES:

FLAG MEDICINES AS 'FREE SAMPLE' ONLY IF MEDICINE WAS CREATED

AT PM07 DURING THE CURRENT ROUND.

Title:

PERSON'S_PRESCRIBED-MEDICINES_1

Roster Details

Beta

Prescribed Medicines (PM) Section

Col #

Header

Instructions

PRESCRIBED

MEDICINE

Display name of prescribed medicine

PMED.PMEDNAME

Roster Behavior:

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a PMED

added on this screen as long as CAPI has not yet created the

link between this PMED and the EVNT. If delete is attempted

at a time when it is not allowed, display the following error

message: ‘DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.’

4. Limited edit allowed. Interviewer may edit the name of a

PMED added on this screen as long as CAPI has not yet created

the link between this PMED and the EVNT. If edit is attempted

at a time when it is not allowed, display the following error

message: ‘EDITING ALLOWED ONLY WHEN MEDICINE IS FIRST

ENTERED.’

5. Any medicine added to the roster should be flagged as

‘created’ this round (with the round status). Any medicine

selected at the roster should be flagged as ‘selected’ this

round (with the round status). This flagging should occur, at

each Person’s-Prescribed-Medicines-Roster throughout the

instrument (unless otherwise specified), the first time the

medicine is added or selected during the round. For example,

if it is Round 1, all medicines on the roster would have the

flag ‘created - Round 1’. If a medicine is created in HS, but

selected in MV, all during round 1, it would only have the

flag ‘created - Round 1’. Thus, for any one round, a medicine

can only be flagged as ‘created’ or ‘selected’. If it is

Round 2 and a medicine that was created in round 1 is

selected, it should be flagged as ‘selected - Round 2’. This

flag is in addition to the original ‘created - Round 1’ flag.

6.When a medicine from a previous round is selected, a new

event is created since it involves a new purchase. A new

purchase requires asking the CHARGE/PAYMENT (CP) section and

pharmacy of the purchase. The reason for including all of the

prescribed medicines on the roster is simply to avoid the

interviewer having to type them in again (if the person is

getting refills of the same medicine every round).

Roster Filter:

Display all; no filter.

Roster Definition:

This item displays the PERSON’S-PRESCRIPTION-MEDICINES-ROSTER

for selection/addition

BOX_01

IF NO MEDICINES FLAGGED AS 'CREATED' OR 'SELECTED' DURING THE CURRENT

ROUND, GO TO BOX_06.

OTHERWISE, CONTINUE WITH LOOP_01.

Beta

Prescribed Medicines (PM) Section

LOOP_01

FOR EACH ELEMENT IN PERSON’S-PRESCRIBED-MEDICINES-ROSTER, ASK BOX_01A-

END_LP01

LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT EACH PRESCRIBED

MEDICINE CREATED OR SELECTED DURING THE CURRENT ROUND. THIS LOOP CYCLES

ON PRESCRIBED MEDICINES THAT MEET ONE OF THE FOLLOWING CONDITIONS:

- PRESCRIBED MEDICINE IS FLAGGED AS ‘CREATED’ DURING THE CURRENT ROUND.

- PRESCRIBED MEDICINE IS FLAGGED AS ‘SELECTED’ DURING THE CURRENT ROUND.

BOX_01A

IF ROUND 5, CONTINUE WITH PM07A.

OTHERWISE, GO TO PM08.

Beta

Prescribed Medicines (PM) Section

PM07A

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION

MEDICINE.} {STR-DT}

{TODAY}

Comment Enabled

Jump Back Enabled

Help Enabled

Now, let's talk about (MEDICINE).

Was (MEDICINE) purchased or obtained sometime between (START DATE)

and (END DATE)?

Size

Variable Name

Label

PRND.R5PMDEL

COUNTER FOR INCORRECT R5 PMEDS

YES

{PM08}

{END_LP01}

Refused

{PM08}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM08}

PROGRAMMER NOTES:

IF CODED '2' (NO), FLAG MEDICINE AS 'INCORRECT'. THIS

MEDICINE SHOULD NOT BE FLAGGED AS 'CREATED' OR 'SELECTED' FOR

ROUND 5 AND THE ROUND 5 RECORDS SHOULD BE DELETED.

Beta

Prescribed Medicines (PM) Section

PM08

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION

MEDICINE.} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

{Now, let’s talk about (MEDICINE).}

Is (MEDICINE) used for a specific health problem?

Size

Variable Name

Label

PMED.HLTHCOND

IS MEDICINE RELATED TO HEALTH CONDITION

YES

{PM09}

{BOX_02A}

Refused

{BOX_02A}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_02A}

DISPLAY INSTRUCTIONS:

DISPLAY 'Now let's talk about (MEDICINE)' IF NOT ROUND 5. IF

ROUND 5, USE A NULL DISPLAY.

Beta

Prescribed Medicines (PM) Section

PM09

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION

MEDICINE.} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What health problem is (MEDICINE) prescribed for?

PROBE: Any other health problems?

IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF

CONDITION) that we have talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.

IF NEW EPISODE OF CONDITION, ADD TO ROSTER.

Size

Variable Name

Label

COND.CONDID

COND ID KEY: PERSID + COUNTER(3) + CD

COND.CONDRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

COND.CREATEQ

QUESTION THAT CREATED COND SEGMENT

COND.CONDNAM

NAME OF CONDITION

CLNK.CLNKID

CLNK ID KEY: CONDID + EVNTID

CLNK.CLNKRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

CLNK.CREATEQ

QUESTION THAT CREATED CLNK SEGMENT

CLNK.CLNKTYPE

TYPE OF EVENT CONDITION IS LINKED TO

CRND.CRNDID

CRND ID KEY: CONDID + ROUND NUMBER

CRND.CRNDRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

CRND.CREATEQ

CREATION STAMP

[Medical Condition]

{BOX_02A}

Title:

PERS_COND_1

Roster Details

Col #

Header

Instructions

MEDICAL CONDITION Display name of medical condition

COND.CONDNAM

Beta

Prescribed Medicines (PM) Section

Roster Behavior:

1. Multiple Select allowed. Selection should NOT impact the

round flag of the condition.

2. Multiple Add allowed. Interviewer should record the

condition name.

3. Limited Delete allowed. Interviewer may delete a

condition added on this screen as long as CAPI has

not yet created the link between this condition and

the event. If the interviewer attempts to delete a

condition when delete is not allowed, display the

following message: “DELETE ALLOWED ONLY

WHEN CONDITION IS FIRST ENTERED.”

4. Limited Edit allowed. Interviewer may edit a condition name

newly added on this screen as long as CAPI has not yet

created the link between this condition and the event. If

the interviewer attempts to edit a condition when edit is

not allowed, display the following message: “EDIT

ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.”

Roster Filter:

Display all conditions on person's roster; no filter.

Roster Definition:

Display the PERSON-MEDICAL-CONDITIONS-ROSTER for the selection

and addition of one or many medical condition(s) associated

with this event.

BOX_02A

IF MEDICINE BEING ASKED ABOUT IS FLAGGED AS 'SELECTED' DURING THE CURRENT

ROUND, GO TO PM10.

IF MEDICINE BEING ASKED ABOUT IS FLAGGED AS 'CREATED' DURING THE CURRENT

ROUND, CONTINUE WITH PM11.

Beta

Prescribed Medicines (PM) Section

PM11

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION

MEDICINE.} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

In what year did (PERSON) first use (MEDICINE)?

Size

Variable Name

Label

PMED.STRTTAKY

YEAR PERSON STARTED TAKING MEDICINE

YYYY:_______

HAS NOT YET TAKEN/USED

{PM10}

Refused

{PM10}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM10}

PROGRAMMER NOTES:

'HAS NOT YET TAKEN/USED' is a radio button under the entry

field.

ROUTING INSTRUCTION:

IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE

WITH PM11OV1.

OTHERWISE, GO TO PM10.

Beta

Prescribed Medicines (PM) Section

PM11OV1

Comment Enabled

Jump Back Enabled

Help Enabled

Size

Variable Name

Label

PMED.STRTTAKM

MONTH PERSON STARTED TAKING MEDICINE

MONTH: _______

Refused

{PM10}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM10}

PROGRAMMER NOTES:

FOR SPECIFICATION PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY):

Allowable values for month are 1-12.

ROUTING INSTRUCTION:

IF YEAR IS REFERENCE YEAR, CONTINUE WITH PM11OV2.

OTHERWISE, GO TO PM10.

Beta

Prescribed Medicines (PM) Section

PM11OV2

Comment Enabled

Jump Back Enabled

Help Enabled

Size

Variable Name

Label

PMED.STRTTAKD

DAY PERSON STARTED TAKING MEDICINE

{PM10}

DAY: _______

Refused

{PM10}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM10}

Hard CHECK:

ENTRIES FOR DAY MUST CORRESPOND TO CALENDAR MONTHS AND DAYS. THAT IS,

- ALLOWABLE VALUES = 01 - 31 IF MONTH CODED ‘01’, ‘03’, ‘05’, ‘07’, ‘08’,

‘10’, ‘12’;

- ALLOWABLE VALUES = 01 - 30 IF MONTH CODED ‘04’, ‘06’, ‘09’, ‘11’;

- ALLOWABLE VALUES = 01 - 29 IF MONTH CODED ‘02’ AND YEAR IS

2008 (LEAP YEAR);

- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED ‘02’ AND YEAR IS NOT

2008 (I.E., NOT LEAP YEAR).

THE COMPLETE DATE CANNOT BE BEFORE THE PERSON'S DATE OF BIRTH OR AFTER THE

REFERENCE PERIOD END DATE FOR THIS PERSON.

Beta

Prescribed Medicines (PM) Section

PM10

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION

MEDICINE.} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

How many times was (MEDICINE) obtained or purchased for (PERSON)

{since (START DATE)/between (START DATE) and (END DATE)}?

Size

Variable Name

Label

PMED.MEDCYCLE

NUMBER OF TIMES MEDICINE WAS OBTAINED

{BOX_02B}

NUMBER OF TIMES: _______

Refused

{BOX_02B}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_02B}

DISPLAY INSTRUCTIONS:

DISPLAY 'since (START DATE)' IF NOT ROUND 5.

DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.

BOX_02B

IF ROUND 3 AND PM10 IS NOT RF OR DK, CONTINUE WITH PM10A.

OTHERWISE, GO TO BOX_02.

Beta

Prescribed Medicines (PM) Section

PM10A

NUMBER OF TIMES OBTAINED/PURCHASED SINCE (START DATE):

{NUMBER OF TIMES}

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION

MEDICINE.} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Of these times, how many were in {YEAR}?

Size

Variable Name

Label

PMED.NOMEDLYR

NUMBER OF TIMES MED OBTAINED LAST YR

{BOX_02}

NUMBER OF TIMES: _______

Refused

{BOX_02}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_02}

DISPLAY INSTRUCTIONS:

FOR 'NUMBER OF TIMES,' DISPLAY THE NUMBER ENTERED AT PM10.

PROGRAMMER NOTES:

FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY):

FOR 'YEAR', DISPLAY THE YEAR THAT IS THE FIRST YEAR OF THE

GIVEN PANEL.

Hard CHECK:

NUMBER OF TIMES MUST BE <= NUMBER OF TIMES OBTAINED/PURCHASED AT PM10.

BOX_02

IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN ASKED FOR THIS MEDICINE,

ASK THE CHARGE/PAYMENT (CP) SECTION.

OTHERWISE, CONTINUE WITH END_LP01.

Beta

Prescribed Medicines (PM) Section

END_LP01

CYCLE ON NEXT MEDICINE IN PERSON’S-PRESCRIBED-MEDICINES-ROSTER THAT MEETS

THE CONDITIONS STATED IN THE LOOP DEFINITION.

IF NO OTHER MEDICINES MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE

WITH BOX_03.

BOX_03

IF ALL PRESCRIBED MEDICINES FOR THIS PERSON ARE FLAGGED AS 'FREE SAMPLES'

(IN BOTH PM AND CP) DURING THE CURRENT ROUND, GO TO BOX_06.

OTHERWISE, CONTINUE WITH LOOP_02.

LOOP_02

FOR EACH OF THE FOLLOWING:

PHARMACY 1

PHARMACY 2

PHARMACY 3

PHARMACY 4

ASK BOX_04A-END_LP02

LOOP DEFINITION: LOOP_02 ENUMERATES PHARMACIES USED BY PERSON FOR

PRESCRIBED MEDICINES THAT WERE CREATED OR SELECTED DURING THE CURRENT

ROUND. THE RESPONSE TO PM17 DETERMINES IF THE LOOP CYCLES AGAIN. IF PM17

IS CODED ‘1’ (YES), THE LOOP CYCLES TO COLLECT THE NEXT PHARMACY USED BY

PERSON. IF PM17 IS CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW),

THE LOOP ENDS.

BOX_04A

AS A PHARMACY IS ENTERED OR SELECTED, FLAG THE PERSON-PHARMACY PAIR WITH

THE CURRENT ROUND (I.E., THE MOST RECENT ROUND IT WAS ENTERED/SELECTED).

THIS ROUND FLAG IS USED TO DETERMINE WHETHER THE PHARMACY IS ELIGIBLE FOR

PHARMACY PERMISSION FORM COLLECTION FOR THIS RU MEMBER.

BOX_04

IF THERE ARE NO PHARMACIES ON THE RU-PHARMACIES- ROSTER, GO TO PM14.

OTHERWISE, CONTINUE WITH PM12.

Beta

Prescribed Medicines (PM) Section

PM12

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What is the name of the (next) pharmacy that filled the prescription(s) for

(PERSON)?

Size

Variable Name

Label

PHAR.PM12BLSWVS

PHAR.PHARID

PHAR ID KEY: RUNTID + COUNTER(3) + CD

PHAR.PHARRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PHAR.CREATEQ

CREATION STAMP

PHAR.PHARNAME

PHARMACY NAME

PHAR.PHARADR1

PHARMACY STREET ADDRESS 1

PHAR.PHARCITY

PHARMACY CITY

PLNK.ACTIVE

PHARMACY ACTIVE DURING RND-RU LET & RND

[Pharmacy]

Refused

{PM13}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM13}

PROGRAMMER NOTES:

Display 'NONE OF THE ABOVE' as the last item on this roster.

ROUTING INSTRUCTION:

IF ‘NONE OF THE ABOVE’ IS SELECTED, GO TO PM14.

OTHERWISE, CONTINUE WITH PM13.

Roster Behavior:

1. Select One allowed. Interviewer must select

one only from the list of providers or may select

NONE OF THE ABOVE.

2. Delete, add, and edit are not allowed.

Roster Definition:

This item displays the RU-PHARMACIES-ROSTER for

selection/addition.

Beta

Prescribed Medicines (PM) Section

Roster Filter:

Display all; no filter.

PM13

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Is the address of (READ NAME AND ADDRESS OF PHARMACY BELOW)…

{PHARMACY NAME SELECTED AT PM12}

{PHARMACY STREET ADDRESS LINE1.}

{PHARMACY STREET ADDRESS LINE2.}

{PHARMACY CITY..,ST,ZIPCODE...}

{PHRM PHONE}

Size

Variable Name

Label

PHAR.PHARVERF

ADDRESS VERIFICATION FOR PHARMACY

PLNK.PLNKID

PLNK ID KEY: PERSID + PHARID

PLNK.PLNKRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PLNK.CREATEQ

QUESTION THAT CREATED PLNK SEGMENT

ADDRESS AND TELEPHONE CORRECT

{BOX_05}

ADD NEW ADDRESS FOR PHARMACY

{PM14}

ABOVE ADDRESS/TELEPHONE NEEDS

CORRECTION

{PM15}

SELECTED WRONG

PHARMACY/ADDRESS

Refused

{BOX_05}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_05}

ROUTING INSTRUCTION:

IF CODED '4' (SELECTED WRONG PHARMACY/ADDRESS), CAPI

REDISPLAYS PM12 TO ALLOW INTERVIEWER TO SELECT CORRECT

PHARMACY.

Beta

Prescribed Medicines (PM) Section

PM14

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(STATE)

What is the name and address of the (next) pharmacy that filled the

prescription(s) for (PERSON)?

Size

Variable Name

Label

PHAR.PHARID

PHAR ID KEY: RUNTID + COUNTER(3) + CD

PHAR.PHARRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PHAR.CREATEQ

CREATION STAMP

PHAR.PHARNAME

PHARMACY NAME

PHAR.PHARADR1

PHARMACY STREET ADDRESS 1

PHAR.PHARADR2

PHARMACY STREET ADDRESS 2

PHAR.PHARCITY

PHARMACY CITY

PHAR.PHARSTAT

PHARMACY STATE

PHAR.PHARZIP

PHARMACY ZIP

PHAR.PHARAREA

PHARMACY AREA CODE

PHAR.PHAREXCH

PHARMACY EXCHANGE

PHAR.PHARLOCL

PHARMACY LOCAL

PLNK.PLNKID

PLNK ID KEY: PERSID + PHARID

PLNK.PLNKRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PLNK.CREATEQ

QUESTION THAT CREATED PLNK SEGMENT

ENTER COMPLETE (NAME AND) ADDRESS AND VERIFY SPELLING.

IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION

WHERE PERSON HAD PRESCRIPTION FILLED.

ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).

PHARMACY_NAME _______________________

PHARMACY_STR1 _______________________

PHARMACY_STR2 _______________________

PHARMACY_CITY _______________________

PHARMACY_STATE _______________________

PHARMACY_ZIPCDE _______________________

{BOX_05}

PHARMACY_PHONE _______________________

Refused

{BOX_05}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_05}

HELP AVAILABLE FOR STATE ABBREVIATIONS.

Beta

Prescribed Medicines (PM) Section

DISPLAY INSTRUCTIONS:

IF PM13 IS CODED ‘2’ (ADD NEW ADDRESS FOR PHARMACY), PM14 WILL

NOT COLLECT THE PHARMACY NAME, PM14_01 WILL DISPLAY THE

PHARMACY NAME AND CANNOT BE EDITED.

PROGRAMMER NOTES:

CODES ‘RF’ (REFUSED) AND ‘DK’ (DON'T KNOW) ARE ALLOWED ON EACH

FORM ITEM EXCEPT FOR PHARMACY NAME (PM14_01).

Hard CHECK:

EDIT: CHECK THAT STATE ABBREVIATION IS VALID.

Beta

Prescribed Medicines (PM) Section

PM15

CORRECT ADDRESS OR TELEPHONE FOR: {PHARMACY NAME

W/WRONG ADDRESS.}

TO VERIFY CURRENT INFORMATION OR TO LEAVE A FIELD BLANK,

PRESS ENTER. TO CORRECT ANY INACCURATE FIELDS, TYPE ENTIRE

FIELD.

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(STATE)

Size

Variable Name

Label

PHAR.PHARADR1

PHARMACY STREET ADDRESS 1

PHAR.PHARADR2

PHARMACY STREET ADDRESS 2

PHAR.PHARCITY

PHARMACY CITY

PHAR.PHARSTAT

PHARMACY STATE

PHAR.PHARZIP

PHARMACY ZIP

PHAR.PHARAREA

PHARMACY AREA CODE

PHAR.PHAREXCH

PHARMACY EXCHANGE

PHAR.PHARLOCL

PHARMACY LOCAL

PLNK.PLNKID

PLNK ID KEY: PERSID + PHARID

PLNK.PLNKRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

PLNK.CREATEQ

QUESTION THAT CREATED PLNK SEGMENT

{BOX_05}

PHARMACY_STR1 _______________________

PHARMACY_STR2 _______________________

PHARMACY_CITY _______________________

PHARMACY_STATE _______________________

PHARMACY_ZIPCDE _______________________

PHARMACY_PHONE _______________________

Refused

{BOX_05}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{BOX_05}

HELP AVAILABLE FOR STATE ABBREVIATIONS.

PROGRAMMER NOTES:

ADDRESS FIELDS CONTAIN PREVIOUSLY COLLECTED INFORMATION WHICH

CAN BE UPDATED.

Beta

Prescribed Medicines (PM) Section

Hard CHECK:

EDIT: CHECK THAT STATE ABBREVIATION IS VALID.

BOX_05

IF THE NAME OR ADDRESS FIELDS WERE COMPLETED IN PM14 FOR THE PHARMACY

BEING ASKED ABOUT (THAT IS, THE PHARMACY WAS ADDED TO THE RU-PHARMACIES-

ROSTER OR A NEW ADDRESS WAS ENTERED FOR AN EXISTING PHARMACY), CONTINUE

WITH PM16.

OTHERWISE, GO TO PM17.

PM16

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(PM16Help)

What type of pharmacy is that? Is it a mail-order pharmacy; a pharmacy

located in another store such as a grocery or department store; a pharmacy

located in an HMO, clinic, or hospital; a drug store that is not located within

another facility; or is it an on-line pharmacy?

Size

Variable Name

Label

PHAR.PHARTYPE

TYPE OF PHARMACY

MAIL-ORDER

{PM17}

IN ANOTHER STORE

{PM17}

IN HMO/CLINIC/HOSPITAL

{PM17}

DRUG STORE

{PM17}

ON-LINE

{PM17}

Refused

{PM17}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{PM17}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

Beta

Prescribed Medicines (PM) Section

PM17

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DATE}

Comment Enabled

Jump Back Enabled

Help Enabled

Did (PERSON) use another pharmacy {since (START DATE)/between

(START DATE) and (END DATE)}?

Size

Variable Name

Label

PHAR.PM17BLSWVS

FOR CHAIN ESTABLISHMENTS, PLEASE RECORD ALL PHARMACY

LOCATIONS USED, (I.E., THOSE WITH THE SAME NAME BUT DIFFERENT

ADDRESS).

YES

{END_LP02}

Refused

{END_LP02}

----------------------------------------------------------------------------------------------------------------------------------

Don't Know

{END_LP02}

DISPLAY INSTRUCTIONS:

DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.

DISPLAY ‘between (START DATE) and (END DATE)’ IF ROUND 5.

END_LP02

IF PM17 IS CODED ‘1’ (YES), CYCLE TO COLLECT INFORMATION ABOUT THE NEXT

PHARMACY USED BY PERSON.

IF PM17 IS CODED ‘2’ (NO), ‘RF' (REFUSED), OR ‘DK’ (DON’T KNOW), END

LOOP_02 AND CONTINUE WITH BOX_06.

BOX_06

GO TO NEXT QUESTIONNAIRE SECTION.

File Type	application/pdf
File Title	C:\PM (BETA).snp
Author	miller_n
File Modified	2005-08-10
File Created	2005-08-10