MEPS-MPC-Fax Package

MPC Patient Data Form SBD.rtf

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

MEPS-MPC-Fax Package

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⚠️ Notice: This form may be outdated.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

Medical Visit (MV) Section

MV01

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Did (PERSON) visit (PROVIDER) on (VISIT DATE) in person or was this a

telephone call?

Size

Variable Name

Label

MVIS.SEETLKPV

DID P VST OUTP PROV IN PERSON OR TELEPHN

SAW PROVIDER

{MV02A}

TELEPHONE CALL

{MV03}

Refused

{MV03}

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

Don't Know

{MV03}

PROGRAMMER NOTES:

IF MV01 IS CODED ‘1’ (SAW PROVIDER), FLAG EVENT AS ‘MV-IN-

PERSON’.

IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘RF’, (REFUSED), OR

‘DK’ (DON’T KNOW), FLAG EVENT AS ‘MV-TELEPHONE’. (FOR PURPOSES

OF QUESTION WORDING IN THIS MV SECTION OF CAPI HOWEVER 'RF'

AND 'DK' WILL USE THE WORDING FOR 'MV-IN-PERSON' EVENTS.)

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Medical Visit (MV) Section

MV02A

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What kind of place is that -- a managed care plan center or HMO, a clinic, a

doctor’s office, or some other place?

Size

Variable Name

Label

MVIS.MVPLACE

KIND OF PLACE PATIENT SAW MV PROVIDER

DOCTOR'S OFFICE OR GROUP

PRACTICE

{MV03}

MEDICAL CLINIC

{MV03}

MANAGED CARE PLAN CENTER/HMO

{MV03}

NEIGHBORHOOD/FAMILY HEALTH

CENTER

{MV03}

LASER EYE SURGERY CENTER

{MV03}

OTHER FREESTANDING SURGICAL

CENTER

{MV03}

RURAL HEALTH CLINIC

{MV03}

COMPANY CLINIC

{MV03}

SCHOOL CLINIC

{MV03}

OTHER CLINIC

{MV03}

WALK-IN URGENT CARE

{MV03}

VA FACILITY

{MV03}

COMMUNITY HEALTH CENTER

{MV03}

LABORATORY/X-RAY FACILITY

{MV03}

BIRTHING CENTER

{MV03}

SOME OTHER PLACE

{MV03}

Refused

{MV03}

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

Don't Know

{MV03}

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Medical Visit (MV) Section

Hard CHECK:

EDIT: IF CODED ‘15’ BIRTHING CENTER, AND PERSON NOT FEMALE, DISPLAY THE

FOLLOWING MESSAGE ‘BIRTHING CENTER' CAN BE SELECTED ONLY IF PERSON IS

FEMALE. VERIFY AND RE-ENTER.

MV03

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(MEDPROVHELP)

{Did (PERSON) see a medical doctor during this particular visit?/Was this

telephone call about (PERSON)’s health with a medical doctor?}

Size

Variable Name

Label

MVIS.SEEDOC

DID P TALK TO MD THIS VISIT/PHONE CALL

YES

{MV03A}

{MV04}

Refused

{MV04}

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

Don't Know

{MV04}

HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.

DISPLAY INSTRUCTIONS:

DISPLAY ‘Did (PERSON) see a medical doctor during this

particular visit?’ IF MV01 IS CODED ‘1’ (SAW PROVIDER), ‘RF’

(REFUSED), OR ‘DK’ (DON’T KNOW) FOR THIS EVENT.

DISPLAY ‘Was this telephone call about (PERSON)’s health with

a medical doctor?’ IF MV01 IS CODED ‘2’ (TELEPHONE CALL) FOR

THIS EVENT.

Beta

Medical Visit (MV) Section

MV03A

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What was the doctor’s specialty?

Size

Variable Name

Label

MVIS.DRSPLTY

MVIS DOCTOR'S SPECIALTY

IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN PROVIDER.

ALLERGY/IMMUNOLOGY

{BOX_01}

ANESTHESIOLOGY

{BOX_01}

CARDIOLOGY (HEART)

{BOX_01}

DERMATOLOGY (SKIN)

{BOX_01}

ENDOCRINOLOGY/METABOLISM

(DIABETES, THYROID)

{BOX_01}

FAMILY PRACTICE

{BOX_01}

GASTROENTEROLOGY

{BOX_01}

GENERAL PRACTICE

{BOX_01}

GENERAL SURGERY

{BOX_01}

GERIATRICS (ELDERLY)

{BOX_01}

GYNECOLOGY/OBSTETRICS

{BOX_01}

HEMATOLOGY (BLOOD)

{BOX_01}

HOSPITAL RESIDENCE

{BOX_01}

INTERNAL MEDICINE (INTERNIST)

{BOX_01}

NEPHROLOGY (KIDNEYS)

{BOX_01}

NEUROLOGY

{BOX_01}

NUCLEAR MEDICINE

{BOX_01}

ONCOLOGY (TUMORS, CANCER)

{BOX_01}

OPTHALMOLOGY (EYES)

{BOX_01}

ORTHOPEDICS

{BOX_01}

OSTEOPATHY (DO)

{BOX_01}

OTORHINOLARYNGOLOGY (EAR,

NOSE, THROAT)

{BOX_01}

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Medical Visit (MV) Section

PATHOLOGY

{BOX_01}

PEDIATRICIAN

{BOX_01}

PHYSICAL MEDICINE/REHAB

{BOX_01}

PLASTIC SURGERY

{BOX_01}

PROCTOLOGY

{BOX_01}

PSYCHIATRY

{BOX_01}

PULMONARY

{BOX_01}

RADIOLOGY

{BOX_01}

RHEUMATOLOGY (ARTHRITIS)

{BOX_01}

THORACIC SURGERY (CHEST)

{BOX_01}

UROLOGY

{BOX_01}

OTHER DR SPECIALTY

{BOX_01}

Refused

{BOX_01}

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

Don't Know

{BOX_01}

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Medical Visit (MV) Section

MV04

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(MV04Help)

What type of medical person did (PERSON) talk to on (VISIT DATE)?

Size

Variable Name

Label

MVIS.MEDPTYPE

TYPE OF MED PERSON P TALKED TO ON VST DT

IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR MAIN

PROVIDER.

CHIROPRACTOR

{BOX_01}

DENTIST/DENTAL CARE PERSON

{BOX_01}

MIDWIFE

{BOX_01}

NURSE/NURSE PRACTITIONER

{BOX_01}

OPTOMETRIST

{BOX_01}

PODIATRIST

{BOX_01}

PHYSICIAN'S ASSISTANT

{BOX_01}

PHYSICAL THERAPIST

{BOX_01}

OCCUPATIONAL THERAPIST

{BOX_01}

PSYCHOLOGIST

{BOX_01}

SOCIAL WORKER

{BOX_01}

TECHNICIAN

{BOX_01}

RECEPTIONIST, CLERK, SECRETARY

{BOX_01}

ACUPUNCTURIST

{BOX_01}

MASSAGE THERAPIST

{BOX_01}

HOMEOPATHIC/NATUROPATHIC/HERBA

LIST

{BOX_01}

OTHER

ALTERNATIVE/COMPLEMENTARY

CARE PROVIDER

{BOX_01}

OTHER

{BOX_01}

Refused

{BOX_01}

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

Beta

Medical Visit (MV) Section

Don't Know

{BOX_01}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

BOX_01

IF MV01 IS CODED '1' (SAW PROVIDER) AND MV03 IS CODED '1' (YES), GO TO

MV07.

IF MV01 IS CODED '2' (TELEPHONE CALL), 'RF' (REFUSED), OR 'DK' (DON'T

KNOW) AND MV03 IS CODED '1' (YES), GO TO MV08.

OTHERWISE, CONTINUE WITH MV06.

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Medical Visit (MV) Section

MV06

TYPE OF PERSON HAD CONTACT: {MEDICAL PERSON TYPE FROM

MV04}

CODE WITHOUT ASKING IF OBVIOUS. OTHERWISE, ASK:

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(MEDPROVHELP)

Do any medical doctors work at {the same location as (PROVIDER)/

(PROVIDER)}?

Size

Variable Name

Label

MVIS.DOCATLOC

ANY MDS WORK AT LOC WHERE P SAW PROV

YES

Refused

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

Don't Know

HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.

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Medical Visit (MV) Section

DISPLAY INSTRUCTIONS:

DISPLAY ‘the same location as (PROVIDER)’ IF PROVIDER IS

FLAGGED AS ‘PERSON-TYPE-PROVIDER’. DISPLAY ‘(PROVIDER)’ IF

PROVIDER IS FLAGGED AS ‘FACILITY-PROVIDER’.

FOR ‘MEDICAL PERSON TYPE FROM MV04’, DISPLAY THE FOLLOWING

TEXT FOR EACH CODE SELECTED AT MV04:

CODE ‘1’ = CHIROPRACTOR

CODE ‘2’ = DENTIST/DENTAL CARE PERSON

CODE ‘3’ = MIDWIFE

CODE ‘4’ = NURSE/NURSE PRACTITIONER

CODE ‘5’ = OPTOMETRIST

CODE ‘6’ = PODIATRIST

CODE ‘7’ = PHYSICIAN’S ASSISTANT

CODE ‘8’ = PHYSICAL THERAPIST

CODE ‘9’ = OCCUPATIONAL THERAPIST

CODE ‘10’= PSYCHOLOGIST

CODE ‘11’= SOCIAL WORKER

CODE ‘12’= TECHNICIAN

CODE ‘13’= RECEPTIONIST/CLERK/SECRETARY

CODE ‘14’= ACUPUNCTURIST

CODE ‘15’= MASSAGE THERAPIST

CODE ‘16’= HOMEOPATHIC/NATUROPATHIC/HERBALIST

CODE ‘17’= OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER

CODE ‘91’= OTHER

CODE ‘RF’= REFUSED PROVIDER TYPE

CODE ‘DK’= DON’T KNOW PROVIDER TYPE

ROUTING INSTRUCTION:

IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘RF’ (REFUSED), OR ‘DK’

(DON’T KNOW), GO TO MV08.

OTHERWISE, CONTINUE WITH MV07.

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Medical Visit (MV) Section

MV07

SHOW CARD MV-1.

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(VSTCTGRYHELP)

Please look at this card and tell me which category best describes the care

(PERSON) received during the visit to (PROVIDER) on (VISIT DATE)?

Size

Variable Name

Label

MVIS.VSTCTGRY

BEST CATEGORY FOR CARE P RECV ON VST DT

GENERAL CHECKUP

{MV08}

DIAGNOSIS OR TREATMENT

{MV08}

EMERGENCY (E.G., ACCIDENT OR

INJURY)

{MV08}

PSYCHOTHERAPY OR MENTAL

HEALTH COUNSELING

{MV08}

FOLLOW-UP OR POST-OPERATIVE

VISIT

{MV08}

IMMUNIZATIONS OR SHOTS

{MV08}

VISION EXAM

{MV08}

PREGNANCY-RELATED (INCLUDING

PRENATAL CARE AND DELIVERY)

{MV08}

WELL CHILD EXAM

{MV08}

LASER EYE SURGERY

{MV08}

OTHER

{MV08}

Refused

{MV08}

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

Don't Know

{MV08}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

Hard CHECK:

EDITS: IF MVO7 IS CODED ‘8’ (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND

DELIVERY)), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING

MESSAGE: CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER.

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Medical Visit (MV) Section

IF MV07 IS CODED ‘9’ (WELL CHILD EXAM), CHECK THAT PERSON IS < 7 YEARS OLD

(OR AGE CATEGORIES 1 THROUGH 3). IF NOT, DISPLAY THE FOLLOWING MESSAGE:

CODE UNAVAILABLE FOR PERSONS 7 AND OLDER. VERIFY AND RE-ENTER.

MV08

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Was this {visit/telephone call} related to any specific health condition or were

any conditions discovered during this {visit/telephone call}?

Size

Variable Name

Label

MVIS.VSTRELCN

THIS VST/PHONE CALL RELATED TO SPEC COND

YES

{MV09}

{BOX_02}

Refused

{BOX_02}

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

Don't Know

{BOX_02}

DISPLAY INSTRUCTIONS:

DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW PROVIDER), ‘RF’

(REFUSED), OR ‘DK’ (DON’T KNOW) FOR THIS EVENT. DISPLAY

‘telephone call’ IF MV01 IS CODED ‘2’(TELEPHONE CALL) FOR THIS

EVENT.

Beta

Medical Visit (MV) Section

MV09

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

What conditions were discovered or led (PERSON) to make this

{visit/telephone call}?

PROBE: Any other condition?

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

CONDITION) that we have already talked about before?

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

COND.STOREVAR

MATRIX TEMPORARY STORAGE VARIABLE

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

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.

IF NEW EPISODE OF CONDITION, ADD TO ROSTER.

[Medical Condition]

{BOX_02}

DISPLAY INSTRUCTIONS:

DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW PROVIDER), ‘RF’

(REFUSED), OR ‘DK’ (DON’T KNOW) FOR THIS EVENT. DISPLAY

‘telephone call’ IF MV01 IS CODED ‘2’(TELEPHONE CALL) FOR THIS

EVENT.

PROGRAMMER NOTES:

DISPLAY 'ADD CONDITION' AS AN OPTION FOR THIS SCREEN.

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Medical Visit (MV) Section

Title:

PERS_COND_1

Roster Details

Col #

Header

Instructions

MEDICAL CONDITION Display name of medical condition

COND.CONDNAM

Roster Behavior:

1. Multiple Select allowed..

2. Multiple Add allowed.

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_02

IF MV01 IS CODED '2' (TELEPHONE CALL), 'RF' (REFUSED), OR 'DK' (DON'T

KNOW), GO TO MV14.

IF MV01 IS CODED '1' (SAW PROVIDER), CONTINUE WITH BOX_03.

BOX_03

IF MV04 IS CODED '2' (DENTIST/DENTAL CARE PERSON), '3' (MIDWIFE), '5'

(OPTOMETRIST), OR '13' (RECEPTIONIST, CLERK, SECRETARY), GO TO MV11.

OTHERWISE, CONTINUE WITH MV10.

Beta

Medical Visit (MV) Section

MV10

SHOW CARD MV-2.

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(TREATMENTSHELP)

Looking at this card, which of these treatments, if any, did (PERSON)

receive during this visit?

Size

Variable Name

Label

MVIS.MV10BLSWVS

MVIS.PHYSTH

THIS VISIT DID P HAVE PHYSICAL THERAPY

MVIS.OCCUPTH

THIS VST DID P HAVE OCCUPATIONAL THERAPY

MVIS.SPEECHTH

THIS VISIT DID P HAVE SPEECH THERAPY

MVIS.CHEMOTH

THIS VISIT DID P HAVE CHEMOTHERAPY

MVIS.RADIATTH

THIS VISIT DID P HAVE RADIATION THERAPY

MVIS.KIDNEYD

THIS VISIT DID P HAVE KIDNEY DIALYSIS

MVIS.IVTHER

THIS VISIT DID P HAVE IV THERAPY

MVIS.DRUGTRT

THIS VST DID P HAVE TRT FOR DRUG OR ALCH

MVIS.RCVSHOT

THIS VST DID P RECEIVE AN ALLERGY SHOT

MVIS.PSYCHOTH

DID P HAVE PSYCHOTHERAPY/COUNSELING?

CHECK ALL THAT APPLY.

PHYSICAL THERAPY

{MV11}

OCCUPATIONAL THERAPY

{MV11}

SPEECH THERAPY

{MV11}

CHEMOTHERAPY

{MV11}

RADIATION THERAPY

{MV11}

KIDNEY DIALYSIS

{MV11}

IV THERAPY

{MV11}

DRUG OR ALCOHOL TREATMENT

{MV11}

ALLERGY SHOT

{MV11}

PSYCHOTHERAPY/COUNSELING

{MV11}

NO TREATMENTS RECEIVED

{MV11}

Refused

{MV11}

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

Don't Know

{MV11}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

Beta

Medical Visit (MV) Section

PROGRAMMER NOTES:

ALLOW CODE '95' (NOT TREATMENTS RECEIVED), 'RF' (REFUSED),

'DK' (DON'T KNOW) AND ALONE ONLY. THESE RESPONSES MAY NOT BE

SELECTED WITH ANY OTHER RESPONSE.

'NO TREATMENT RECEIVED' IS NOT DISPLAYED ON SHOW CARD.

Hard CHECK:

EDIT: IF CODED '95' (NO TREATMENTS RECEIVED), NO OTHER TREATMENT CATEGORIES

CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO TREATMENTS'

DISPLAY THE FOLLOWING MESSAGE: 'NO TREATMENTS RECEIVED CANNOT BE SELECTED

WITH OTHER OPTIONS. VERIFY AND RE-ENTER'.

Beta

Medical Visit (MV) Section

MV11

SHOW CARD MV-3.

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(MEDSERVHELP)

Looking at this card, which of these services, if any, did (PERSON) have

during this visit?

Size

Variable Name

Label

MVIS.MV11BLSWVS

MVIS.LABTEST

THIS VISIT DID P HAVE LAB TESTS

MVIS.SONOGRAM

THIS VST DID P HAVE SONOGRAM OR ULTRSD

MVIS.XRAYS

THIS VISIT DID P HAVE XRAYS

MVIS.MAMMOG

THIS VISIT DID P HAVE A MAMMOGRAM

MVIS.MRI

THIS VISIT DID P HAVE AN MRI/CATSCAN

MVIS.EKG

THIS VISIT DID P HAVE AN EKG OR ECG

MVIS.EEG

THIS VISIT DID P HAVE A EEG

MVIS.RCVVAC

THIS VISIT DID P RECEIVE A VACCINATION

MVIS.ANESTH

DURING THIS VISIT P RECEIVE ANESTHESIA

MVIS.OTHSVCE

THIS VST DID P HAVE OTH DIAG TSTS/EXAMS

MVIS.THRTSWAB

CHECK ALL THAT APPLY.

LABORATORY TESTS

{MV12}

THROAT SWAB

{MV12}

SONOGRAM OR ULTRASOUND

{MV12}

X-RAYS

{MV12}

MAMMOGRAM

{MV12}

MRI OR CATSCAN

{MV12}

EKG OR ECG

{MV12}

EEG

{MV12}

VACCINATION

{MV12}

ANESTHESIA

{MV12}

OTHER DIAGNOSTIC TEST

{MV12}

NO SERVICES RECEIVED

{MV12}

Refused

{MV12}

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

Beta

Medical Visit (MV) Section

Don't Know

{MV12}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

PROGRAMMER NOTES:

ALLOW CODE ‘4’ (MAMMOGRAM) ONLY IF PERSON IS FEMALE AND AGE IS

> 17 YEARS (OR AGE CATEGORIES 4 THROUGH 9).

ALLOW CODE '95' (NO SERVICES RECEIVED), 'RF' (REFUSED) 'DK'

(DON'T KNOW) AND ALONE ONLY. THESE RESPONSES MAY NOT BE

SELECTED WITH ANY OTHER RESPONSE.

'NO SERVICES RECEIVED' IS NOT DISPLAYED ON SHOW CARD.

Hard CHECK:

EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER TREATMENT CATEGORIES

CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO SERVICES',

DISPLAY THE FOLLOWING MESSAGE: 'NO SERVICES RECEIVED CANNOT BE SELECTED WITH

OTHER OPTIONS. VERIFY AND RE-ENTER'.

MV12

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(SURGPROCHELP)

Was a surgical procedure performed on (PERSON) during this visit?

Size

Variable Name

Label

MVIS.SURGPROC

WAS SURG PROC PERFORMED ON P THIS VISIT

YES

{MV14}

Refused

{MV14}

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

Don't Know

{MV14}

HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.

Beta

Medical Visit (MV) Section

MV14

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(MEDPRESHELP)

During this {visit/telephone call}, were any medicines prescribed for

(PERSON)? Please include only prescriptions which were filled.

Size

Variable Name

Label

MVIS.MEDPRESC

ANY MEDICINS PRESCRIBED FOR P THIS VISIT

YES

{MV15}

{BOX_04}

Refused

{BOX_04}

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

Don't Know

{BOX_04}

HELP AVAILABLE FOR DEFINITION OF PRESCRIBED MEDICINE.

DISPLAY INSTRUCTIONS:

DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW PROVIDER), ‘RF’

(REFUSED), OR ‘DK’ (DON’T KNOW) FOR THIS EVENT. DISPLAY

‘telephone call’ IF MV01 IS CODED ‘2’(TELEPHONE CALL) FOR THIS

EVENT.

Beta

Medical Visit (MV) Section

MV15

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Please tell me the names of the prescriptions from this visit that were filled.

PROBE: Any other prescribed medicines from this visit that were filled?

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

PMED.STOREVAR

MATRIX TEMPORARY STORAGE VARIABLE

RXLK.RXLKID

RXLK ID KEY: EVENTID + PMEDID

RXLK.RXLKRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

RXLK.CREATEQ

QUESTION THAT CREATED RXLK RECORD

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

DRUG.STOREVAR

MATRIX TEMPORARY STORAGE VARIABLE

[Prescribed Medicine]

{BOX_04}

[Prescribed Medicine]

{BOX_04}

[Prescribed Medicine]

{BOX_04}

PROGRAMMER NOTES:

DISPLAY 'ADD MEDICINE' AS AN OPTION ON THIS SCREEN.

Beta

Medical Visit (MV) Section

Title:

PERSON'S_PRESCRIBED-MEDICINES_1

Roster Details

Col #

Header

Instructions

PRESCRIBED

MEDICINE

Display name of prescribed medicine

DRUG.DRUGNAME

Roster Behavior:

1. Multiple Select and add allowed.

2. 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 event.

If the interviewer attempts to delete a PMED name when

delete is not allowed, display the following message:

“DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST

ENTERED.”

3. 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

event. If the interviewer attempts to edit a PMED

name when editing is not allowed, display the following

message: “EDITING ALLOWED ONLY WHEN MEDICINE

IS FIRST ENTERED.”

Roster Filter:

Display all medicines in person's roster; no filter.

Roster Definition:

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

for selection.

BOX_04

IF MV01 IS CODED '1' (SAW PROVIDER), CONTINUE WITH BOX_05.

IF MV01 IS CODED '2' (TELEPHONE CALL), 'RF' (REFUSED), OR 'DK' (DON'T

KNOW), GO TO BOX_07.

BOX_05

IF NO CONDITION IS ASSOCIATED WITH THIS VISIT TO THIS PROVIDER FOR THIS

PERSON, GO TO BOX_07.

OTHERWISE, CONTINUE WITH BOX_06.

Beta

Medical Visit (MV) Section

BOX_06

IF 2 OR MORE VISITS TO THIS PROVIDER FOR THIS PERSON HAVE NOT COMPLETED

THE MEDICAL PROVIDER VISITS UTILIZATION MODULE AND IF THIS EVENT IS NOT

PART OF A FLAT FEE GROUP, CONTINUE WITH MV16.

OTHERWISE, GO TO BOX_07.

Beta

Medical Visit (MV) Section

MV16

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(REPEATVSTHELP)

Earlier I recorded that (PERSON) had some other visits to (PROVIDER).

Were any of these visits related to any condition associated with (PERSON)’s

visit on (VISIT DATE)? That is, were any of the other visits for the (READ

CONDITIONS BELOW) and did (PERSON) receive {(READ SERVICES

BELOW)/the same services}?

CONDITIONS

SERVICES

{PERSON'S MV CONDITION}

{SERVICES RECEIVED}

{PERSON'S MV CONDITION}

{SERVICES RECEIVED}

{PERSON'S MV CONDITION}

{SERVICES RECEIVED}

Size

Variable Name

Label

MVIS.SAMECOND

ANY VST FOR COND WHICH P RECVD SERVICES

YES

{MV17}

{BOX_07}

Refused

{BOX_07}

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

Don't Know

{BOX_07}

HELP AVAILABLE FOR DEFINITION OF REPEAT VISITS.

Beta

Medical Visit (MV) Section

DISPLAY INSTRUCTIONS:

DISPLAY ‘(READ SERVICES BELOW)’ IF MV11 IS NOT CODED ‘95’ (NO

SERVICES RECEOVED), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW). IF

MV11 IS CODED ‘95’ (NO SERVICES RECEIVED), ‘RF’ (REFUSED), OR

‘DK’ (DON’T KNOW), DISPLAY ‘the same services’.

FOR ‘PERSON’S MV MEDICAL CONDITION’ , DISPLAY ALL CONDITIONS

SELECTED FROM OR ADDED TO PERSON’S-MEDICAL-CONDITIONS-ROSTER

AT MV09.

FOR ‘SERVICES RECEIVED’ , DISPLAY THE FOLLOWING TEXT FOR EACH

SERVICE SELECTED AT MV11:

CODE ‘1’ = LABORATORY TESTS

CODE ‘2’ = SONOGRAM/ULTRASOUND

CODE ‘3’ = X-RAYS

CODE ‘4’ = MAMMOGRAM

CODE ‘5’ = MRI/CATSCAN

CODE ‘6’ = EKG/ECG

CODE ‘7’ = EEG

CODE ‘8’ = VACCINATION

CODE ‘9’ = ANESTHESIA

CODE ‘10’ = OTHER SERVICES

CODE '11' = THROAT SWAB

Beta

Medical Visit (MV) Section

MV17

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

(SAMEAMTHELP)

Did any of these visits or calls cost the same amount as (PERSON)’s visit on

(VISIT DATE)?

Size

Variable Name

Label

MVIS.SAMEAMT

ANY VISIT COST THE SAME AMOUNT AS STEM

YES

{MV18}

{BOX_07}

Refused

{BOX_07}

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

Don't Know

{BOX_07}

HELP AVAILABLE FOR DEFINITION OF COST THE SAME AMOUNT.

PROGRAMMER NOTES:

THE ISSUES OF COST WHEN THE PERSON HAS A COPAY AND DOES NOT

KNOW THE TOTAL CHARGE WILL BE HANDLED IN THE HELP DEFINITION.

Beta

Medical Visit (MV) Section

MV18

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Which of the following visits were related to the (READ CONDITIONS

BELOW) and {(READ SERVICES BELOW)/the same services} and cost the

same amount as the (VISIT DATE) visit we’ve just talked about?

PROBE: Any other visits related to this condition and cost the same amount?

CONDITIONS

SERVICES

{PERSON'S MV CONDITION}

{SERVICES RECEIVED}

{PERSON'S MV CONDITION}

{SERVICES RECEIVED}

{PERSON'S MV CONDITION}

{SERVICES RECEIVED}

Size

Variable Name

Label

EVNT.RVTYPE

REPEAT VISIT TYPE - STEM/LEAF

EVNT.RVSTEM

4-DIGIT EVENT NUMBER OF STEM RV

EVNT.PROCFLAG

EVNT UTILIZATION PROCESS FLAG

EVNT.STOREVAR

MATRIX TEMPORARY STORAGE VARIABLE

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

EVPV.RVTYPE

REPEAT VISIT TYPE - STEM/LEAF

EVPV.RVSTEM

4-DIGIT EVENT NUMBER OF STEM RV

EVPV.CPFLAG

CHARGE PAYMENT PROCESS FLAG

MVIS.MVISID

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

MVIS.CREATEQ

CREATION STAMP

MVIS.MVISRURN

ROUND STAMP: RU LETTER + ROUND NUMBER

[Month, Day, Year]

{MV19}

Beta

Medical Visit (MV) Section

DISPLAY INSTRUCTIONS:

DISPLAY ‘(READ SERVICES BELOW)’ IF MV11 IS NOT CODED ‘95’ (NO

SERVICES RECEIVED), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW). IF

MV11 IS CODED ‘95’ (NO SERVICES RECEIVED), ‘RF’ (REFUSED), OR

‘DK’ (DON’T KNOW), DISPLAY ‘the same services’.

FOR ‘PERSON’S MV MEDICAL CONDITION’ , DISPLAY ALL CONDITIONS

SELECTED OR ADDED TO PERSON’S-MEDICAL-CONDITIONS-ROSTER AT

MV09.

FOR ‘SERVICES RECEIVED..’, DISPLAY THE FOLLOWING TEXT FOR EACH

SERVICE SELECTED AT MV11:

CODE ‘1’ = LABORATORY TESTS

CODE ‘2’ = SONOGRAM/ULTRASOUND

CODE ‘3’ = X-RAYS

CODE ‘4’ = MAMMOGRAM

CODE ‘5’ = MRI/CATSCAN

CODE ‘6’ = EKG/ECG

CODE ‘7’ = EEG

CODE ‘8’ = VACCINATION

CODE ‘9’ = ANESTHESIA

CODE '10' = OTHER SERVICES

CODE '11' = THROAT SWAB

PROGRAMMER NOTES:

FLAG EACH VISIT SELECTED AT MV18 AS A REPEAT VISIT RELATED TO

THE EVENT BEING ASKED ABOUT.

FLAG THE CHARGE PAYMENT (CP) STATUS OF EACH REPEAT VISIT AS

‘PROCESSED’.

LINK CONDITION(S) AND SERVICE(S) ASSOCIATED WITH THE EVENT

BEING ASKED ABOUT WITH EACH REPEAT VISIT.

THE EVENT DRIVER WILL NOT SERVE THESE REPEAT VISITS FOR THE MV

SECTION.

Title:

PERS_EVNT_1

Roster Details

Col #

Header

Instructions

MONTH/DAY/YEAR

Display Event Begin Date

EVNT.EVNTBEGM

EVNT.EVNTBEGD

EVNT.EVNTBEGY

Roster Behavior:

1. Multiple select allowed.

Roster Definition:

This item displays all medical events (dates) on person’s-

medical-events-roster for selection.

Beta

Medical Visit (MV) Section

2. Add, delete, and edit disallowed.

Roster Filter:

Display only those events with the following characteristics.

1. Event was created this round.

2. Event has not been processed in utilization.

3. Event has event type ‘MV’.

4. Event is associated with the same provider

as the event being asked about.

MV19

INTERVIEWER: RECORD ‘NAME OF REPEAT VISIT GROUP’ FOR

EVENTS SELECTED IN PREVIOUS QUESTION:

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE

PROVIDER} {EVN-DT}

Comment Enabled

Jump Back Enabled

Help Enabled

Size

Variable Name

Label

EVPV.RVTYPE

REPEAT VISIT TYPE - STEM/LEAF

EVNT.RVTYPE

REPEAT VISIT TYPE - STEM/LEAF

EVNT.RVNAME

NAME OF REPEAT VISIT GROUP

EVPV.RVNAME

NAME OF REPEAT VISIT GROUP

{BOX_07}

NAME: _______________________

Beta

Medical Visit (MV) Section

BOX_07

IF THE CHARGE/PAYMENT (CP) SECTION IS NOT COMPLETED FOR THIS MEDICAL

PROVIDER VISIT (MV) EVENT, GO TO THE CHARGE/PAYMENT (CP) SECTION.

OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.

File Type	application/pdf
File Title	\\rk29\vol2905\MEPSWVS\SpecWriter\BETA\mv (beta).snp
Author	miller_n
File Modified	2005-12-21
File Created	2005-12-21