Beta
Home Health (HH) Section
BOX_00
IF NOT ROUND 5 AND EVENT MONTH IS INTERVIEW MONTH, GO TO BOX_05
OTHERWISE, CONTINUE WITH BOX_01
BOX_01
IF PROVIDER IS FLAGGED AS ‘AGENCY’, CONTINUE WITH HH01
OTHERWISE, GO TO HH03
1
Beta
Home Health (HH) Section
HH01
SHOW CARD HH-1
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
(HH01Help)
Please look at this card. During (VISIT MONTH), what types of health care
workers from (PROVIDER) provided home care services for (PERSON)?
Size
Variable Name
Label
HVIS.WORKERSBLSWVS
HVIS.CNA
2
TYPE OF HEALTH CARE WORKER - CERT NURS ASST
HVIS.COMPANN
2
TYPE OF HEALTH CARE WORKER - COMPANION
HVIS.DIETICN
2
TYPE OF HEALTH CARE WORKER - DIETITION/NUTRT
HVIS.HHAIDE
2
TYPE OF HEALTH CARE WORKER - HOME CARE AIDE
HVIS.HOSPICE
2
TYPE OF HEALTH CARE WORKER - HOSPICE WRKR
HVIS.HMEMAKER
2
TYPE OF HEALTH CARE WORKER
HVIS.IVTHP
2
TYPE OF HEALTH CARE WORKER - IV THERAPIST
HVIS.MEDLDOC
2
TYPE OF HEALTH CARE WORKER - MEDICAL DR
HVIS.NURPRACT
2
TYPE OF HEALTH CARE WORKER - NURSE/PRACTR
HVIS.NURAIDE
2
TYPE OF HEALTH CARE WORKER - NURSES AIDE
HVIS.OCCUPTHP
2
TYPE OF HEALTH CARE WORKER - OCCUP THERAP
HVIS.PERSONAL
2
TYPE OF HEALTH CARE WORKER - PERS CARE ATTDT
HVIS.PHYSLTHP
2
TYPE OF HEALTH CARE WORKER - PHYSICAL THERAP
HVIS.RESPTHP
2
TYPE OF HEALTH CARE WORKER - RESPIR THERAP
HVIS.SOCIALW
2
TYPE OF HEALTH CARE WORKER - SOCIAL WORKER
HVIS.SPEECTHP
2
TYPE OF HEALTH CARE WORKER - SPEECH THERAP
HVIS.OTHRHCW
2
TYPE OF HEALTH CARE WORKER - OTHER
EVNT.PROCFLAG
2
EVNT UTILIZATION PROCESS FLAG
CHECK ALL THAT APPLY.
1
CERTIFIED NURSING ASSISTANT (CNA)
2
COMPANION
3
DIETITIAN/NUTRITIONIST
4
HOME HEALTH/HOME CARE AIDE
5
HOSPICE WORKER
6
HOMEMAKER
7
I.V. OR INFUSION THERAPIST
8
MEDICAL DOCTOR
9
NURSE/NURSE PRACTITIONER
10
NURSE'S AIDE
2
Beta
Home Health (HH) Section
11
OCCUPATIONAL THERAPIST
12
PERSONAL CARE ATTENDANT
13
PHYSICAL THERAPIST
14
RESPIRATORY THERAPIST
15
SOCIAL WORKER
16
SPEECH THERAPIST
91
SOME OTHER TYPE OF HEALTH CARE
WORKER
{HH02}
RF
Refused
{HH03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH03}
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
PROGRAMMER NOTES:
'SOME OTHER TYPE OF HEALTH CARE WORKER' NOT DISPLAYED ON SHOW
CARD.
FOR SPECIFICATIONS PURPOSES ONLY (THIS CHECK IS AUTOMATIC):
CAPI DOES NOT ALLOW 'RF' OR 'DK' IN COMBINATION
WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE),
CONTINUE WITH HH02
OTHERWISE, GO TO HH03
Context Header Display Instructions:
DISPLAY EVNT.EVNTBEGM AS THREE LETTERS.
3
Beta
Home Health (HH) Section
HH02
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
What type of health care worker was it?
Size
Variable Name
Label
HVIS.WORKERS2BLSWVS
HVIS.NONSKILL
2
TYPE OF HEALTH CARE WORKER - NON-SKILLED
HVIS.SKILLED
2
TYPE OF HEALTH CARE WORKER - SKILLED
HVIS.OTHCW
2
TYPE OF HEALTH CARE WORKER - SOME OTHER
CHECK ALL THAT APPLY.
1
NON-SKILLED WORKER (ANY TYPE OF
WORKER WHO PROVIDES HOME CARE
SERVICES WHICH GENERALLY FALL
INTO COMPANION, HOMEMAKER,
PERSONAL CARE CATEGORIES.
THESE WORKERS MAY ALSO
PERFORM MINOR HEALTH CARE
ACTIVITIES SUCH AS ADMINISTERING
MEDICATIONS.)
2
SKILLED WORKER
91
OTHER TYPE OF HEALTH CARE
WORKER
RF
Refused
{HH03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH03}
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY (THIS CHECK IS AUTOMATIC):
CAPI DOES NOT ALLOW 'RF' OR 'DK' IN COMBINATION WITH ANY OTHER
CODE.
4
Beta
Home Health (HH) Section
ROUTING INSTRUCTION:
IF CODED '1' (NON-SKILLED WORKER) ALONE, GO TO HH03
IF CODED '2' (SKILLED WORKER) ALONE OR IN COMBINATION WITH ANY
OTHER CODE, CONTINUE WITH HH02OV1
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY CODE EXCEPT
'2'), GO TO HH02OV2
Hard CHECK:
Refused and Don't Know cannot be entered in conjuction with any other code.
HH02OV1
Comment Enabled
Jump Back Enabled
Help Enabled
Size
Variable Name
Label
HVIS.SKILLWOS
25
SPECIFY TYPE OF SKILLED WORKER
_______________________
TYPE OF SKILLED
WORKER:
RF
Refused
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
ROUTING INSTRUCTION:
IF RESPONSE TO HH02 INCLUDES CODE '91', CONTINUE WITH HH02OV2
OTHERWISE, GO TO HH03
5
Beta
Home Health (HH) Section
HH02OV2
Comment Enabled
Jump Back Enabled
Help Enabled
Size
Variable Name
Label
HVIS.OTHCWOS
25
SPECIFY OTHER TYPE HLTH CARE WORKER
{HH03}
_______________________
OTHER TYPE OF
HEALTH CARE
WORKER:
RF
Refused
{HH03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH03}
6
Beta
Home Health (HH) Section
HH03
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
(HH03Help)
Thinking about the home care services (PERSON) (have/has) received from
{someone from} (PROVIDER) during (VISIT MONTH), were any of these
home care services because of a hospitalization, either before or after
{PERSON’S STR-DT}?
Size
Variable Name
Label
HVIS.HOSPITAL
2
ANY HH CARE SVCE DUE TO HOSPITALIZATION
1
YES
{HH04}
2
NO
{HH04}
RF
Refused
{HH04}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH04}
HELP AVAILABLE FOR DEFINITION OF HOSPITALIZATION.
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
DISPLAY THE REFERENCE PERIOD START DATE FOR THE PERSON BEING
ASKED ABOUT FOR ‘PERSON’S STR-DT’.
7
Beta
Home Health (HH) Section
HH04
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
(HH04Help)
Thinking about all of the home care services (PERSON) (have/has) received
from {someone from} (PROVIDER) during (VISIT MONTH), were any of these
home care services related to any specific health problem?
Size
Variable Name
Label
HVIS.VSTRELCN
2
ANY HH CARE SVCE RELATED TO HLTH COND
IF OLD AGE MENTIONED, SELECT 'YES' AND ENTER ‘OLD AGE’ AS
CONDITION.
1
YES
{HH05}
2
NO
{BOX_02}
RF
Refused
{BOX_02}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_02}
HELP AVAILABLE FOR DEFINITION OF HEALTH PROBLEM.
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
8
Beta
Home Health (HH) Section
HH05
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
What health condition led (PERSON) to receive home health care services
from {someone from} (PROVIDER) during (VISIT MONTH)?
PROBE: Any other health condition?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF
CONDITION) that we have already 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
12
COND ID KEY: PERSID + COUNTER(3) + CD
COND.CONDRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
COND.CREATEQ
4
QUESTION THAT CREATED COND SEGMENT
COND.CONDNAM
30
NAME OF CONDITION
CLNK.CLNKID
24
CLNK ID KEY: CONDID + EVNTID
CLNK.CLNKRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
CLNK.CREATEQ
4
QUESTION THAT CREATED CLNK SEGMENT
CLNK.CLNKTYPE
2
TYPE OF EVENT CONDITION IS LINKED TO
CRND.CRNDID
13
CRND ID KEY: CONDID + ROUND NUMBER
CRND.CRNDRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
CRND.CREATEQ
2
CREATION STAMP
[Medical Condition]
[Medical Condition]
[Medical Condition]
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
OTHERWISE, USE A NULL DISPLAY.
Title:
PERS_COND_1
Roster Details
9
Beta
Home Health (HH) Section
Col #
Header
Instructions
1
MEDICAL CONDITION Display name of medical condition
COND.CONDNAM
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's-Medical-Conditions-Roster for the
selection and addition of one or many medical condition(s)
associated with this event.
BOX_02
IF PROVIDER FLAGGED AS ‘INFORMAL’, GO TO HH08
OTHERWISE, CONTINUE WITH HH06
10
Beta
Home Health (HH) Section
HH06
SHOW CARD HH-2.
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
(HH06Help)
Please look at the top of this card.
During (VISIT MONTH), did {someone from} (PROVIDER) help (PERSON) by
providing medical treatments or any type of therapy?
PROBE: Medical treatments include things like changing bandages, wound
care, giving medication, taking blood pressure, or giving shots or injections.
Therapy includes physical, occupational, and speech therapy.
Size
Variable Name
Label
HVIS.TREATMT
2
PERSON RECEIVED MEDICAL TREATMENT
1
YES, AT LEAST ONCE
{HH07}
2
NO
{HH07}
RF
Refused
{HH07}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH07}
HELP AVAILABLE FOR OTHER EXAMPLES OF MEDICAL TREATMENTS
AND THERAPY.
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
11
Beta
Home Health (HH) Section
HH07
SHOW CARD HH-2.
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
Now look at the gray area in the middle of the card.
During (VISIT MONTH), did {someone from} (PROVIDER) provide or teach
(PERSON) or a friend or relative how to use any medical equipment or
assistive device
, such as the items listed on this card?
PROBE: For example, an oxygen tank, a wheelchair, a walker, a hospital
bed, a tub seat, or a special railing or commode.
Size
Variable Name
Label
HVIS.MEDEQUIP
2
PERSON WAS TAUGHT USE OF MED EQUIPMT
1
YES, AT LEAST ONCE
{HH08}
2
NO
{HH08}
RF
Refused
{HH08}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH08}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
12
Beta
Home Health (HH) Section
HH08
{SHOW CARD HH-2/SHOW CARD HH-3.}
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
{Now look at the bottom of this card.}
During (VISIT MONTH), did {someone from} (PROVIDER) help (PERSON)
with daily activities or personal care tasks, such as those listed on this
card?
PROBE: For example, using the telephone, paying bills, shopping, driving,
doing housework, preparing meals, bathing, dressing, using the toilet, getting
in or out of a bed or chair, walking or eating.
Size
Variable Name
Label
HVIS.DAILYACT
2
PERSON WAS HELPED WITH DAILY ACTIVITIES
1
YES, AT LEAST ONCE
{HH09}
2
NO
{HH09}
RF
Refused
{HH09}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH09}
DISPLAY INSTRUCTIONS:
DISPLAY ‘SHOW CARD HH-2.’ AND ‘Now look at the bottom of this
card.’ IF PROVIDER IS FLAGGED AS ‘AGENCY’ OR ‘PAID
INDEPENDENT’.
DISPLAY ‘SHOW CARD HH-3.’ IF PROVIDER IS FLAGGED AS ‘INFORMAL’.
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
13
Beta
Home Health (HH) Section
HH09
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
During (VISIT MONTH), did {someone from} (PROVIDER) provide
companionship or company for (PERSON)?
PROBE: For example, reading, watching T.V., playing games, going for a
walk or to a restaurant, or just being together.
Size
Variable Name
Label
HVIS.COMPANY
2
PERSON RECEIVED COMPANIONSHIP SERVICES
1
YES, AT LEAST ONCE
{HH10}
2
NO
{HH10}
RF
Refused
{HH10}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH10}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
14
Beta
Home Health (HH) Section
HH10
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
Did {someone from} (PROVIDER) provide (PERSON) with any other home
care services we have not yet talked about?
Size
Variable Name
Label
HVIS.OTHSVCE
2
PERSON RECEIVED OTHER HOME CARE SERVICES
1
YES, AT LEAST ONCE
{HH10OV}
2
NO
{HH11}
RF
Refused
{HH11}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH11}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
15
Beta
Home Health (HH) Section
HH10OV
Comment Enabled
Jump Back Enabled
Help Enabled
What other services?
Size
Variable Name
Label
HVIS.OTHSVCOS
25
SPECIFY OTHER HOME CARE SERVICE RECEIVED
{IF MEDICAL TREATMENT OR THERAPY MENTIONED, BACKUP TO HH06
TO BE SURE 'YES' IS CODED.
IF MEDICAL EQUIPMENT OR ASSISTIVE DEVICE MENTIONED, BACKUP
TO HH07 TO BE SURE 'YES' IS CODED.}
IF DAILY ACTIVITIES OR PERSONAL CARE TASKS MENTIONED,
BACKUP TO HH08 TO BE SURE 'YES' IS CODED.
IF COMPANIONSHIP MENTIONED, BACKUP TO HH09 TO BE SURE 'YES'
IS CODED.
{HH11}
Other Services: _______________________
RF
Refused
{HH11}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HH11}
DISPLAY INSTRUCTIONS:
DISPLAY ‘IF MEDICAL TREATMENT OR THERAPY MENTIONED, BACKUP TO
BE SURE 'YES' IS CODED...' IF PROVIDER IS FLAGGED AS ‘AGENCY’
OR ‘PAID INDEPENDENT’.
16
Beta
Home Health (HH) Section
HH11
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
Generally speaking, during (VISIT MONTH), did {someone from} (PROVIDER)
come to the home to help (PERSON) every week or only during some
weeks?
Size
Variable Name
Label
HVIS.FREQCY
2
PROVIDER HELPED PERSON EVERY WK/SOME WKS
1
EVERY WEEK
{HH12}
2
SOME WEEKS
{HH13}
3
ONLY CAME ONCE
{HH16}
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
17
Beta
Home Health (HH) Section
HH12
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
During (VISIT MONTH), about how many days per week did {someone from}
(PROVIDER) come?
PROBE: We just need to know in general.
Size
Variable Name
Label
HVIS.DAYSPWK
2
NUMBER OF DAYS PER WEEK PROVIDER CAME
{HH14}
Number of Days Per
Week
_______
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY (RANGE IS DETERMINED IN
PROGRAM): ALLOW RESPONSES 1-7 ONLY.
18
Beta
Home Health (HH) Section
HH13
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
About how many days during (VISIT MONTH) did {someone from}
(PROVIDER) come?
PROBE: We just need to know in general.
Size
Variable Name
Label
HVIS.DAYSPMO
2
NUMBER OF DAYS PER MONTH PROVIDER CAME
{HH14}
Number of Days Per
Month:
_______
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
Hard CHECK:
WVS ERROR HANDLER WILL DISPLAY AN ERROR MESSAGE AND FORCE THE INTERVIEWER TO
RECTIFY THE DATA IF ANY OF THE FOLLOWING SITUATIONS OCCUR:
IF (VISIT MONTH) IS: JANUARY, MARCH, MAY, JULY, AUGUST, OCTOBER OR
DECEMBER: 1-31 FOR NUMBER OF DAYS.
IF (VISIT MONTH) IS: APRIL, JUNE, SEPTEMBER OR NOVEMBER: 1-30 FOR NUMBER
OF DAYS.
IF (VISIT MONTH) IS: FEBRUARY: 1-29 FOR NUMBER OF DAYS IF 2008.
OTHERWISE, 1-28 FOR NUMBER OF DAYS.
19
Beta
Home Health (HH) Section
HH14
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
During (VISIT MONTH), did {someone from} (PROVIDER) come once per day
or more than once per day?
PROBE: We just need to know in general.
Size
Variable Name
Label
HVIS.HOWOFTEN
2
PROV CAME ONCE PER DAY/MORE THAN ONCE
1
ONCE PER DAY
{HH16}
2
MORE THAN ONCE PER DAY
{HH15}
3
24 HOURS PER DAY
{BOX_03}
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
20
Beta
Home Health (HH) Section
HH15
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
During (VISIT MONTH), how many times per day did {someone from}
(PROVIDER) come to the home to help (PERSON)?
PROBE: We just need to know in general.
Size
Variable Name
Label
HVIS.TMSPDAY
3
TIMES PER DAY PROVIDER CAME HOME TO HELP
{HH16}
NUMBER OF TIMES
PER DAY
_______
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS FLAGGED AS ‘AGENCY’.
Hard CHECK:
ALLOW ONLY 2 - 6 FOR NUMBER OF TIMES PER DAY
21
Beta
Home Health (HH) Section
HH16
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
How long did {each visit usually/the visit} last?
PROBE: We just need to know in general.
IF RESPONSE IS LESS THAN ONE HOUR, ENTER '0' FOR HOURS.
Size
Variable Name
Label
HVIS.MINLONG
2
MINUTES EACH VISIT LASTED
HVIS.HRSLONG
2
HOURS EACH VISIT LASTED
Hours _______
{BOX_03}
Minutes _______
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY 'each visit usually' IF HH11 IS NOT CODED '3' (ONLY
CAME ONCE).
DISPLAY 'the visit' IF HH11 IS CODED '3' (ONLY CAME ONCE).
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES THIS
AUTOMATICALLY): ALLOW 0-24 FOR HOURS AND 0-59 FOR MINUTES.
ROUTING INSTRUCTION:
IF 'RF', 'DK', OR '24' ENTERED FOR HOURS, GO TO BOX_03.
Hard CHECK:
IF '0' ENTERED IN BOTH HOURS AND MINUTES, THE WVS ERROR HANDLER WILL FORCE
THE INTERVIEWER TO RECTIFY THE DATA.
22
Beta
Home Health (HH) Section
BOX_03
IF 2 OR MORE MONTHS, EXCLUDING INTERVIEW MONTH, FOR THIS PROVIDER FOR THIS
PERSON HAVE NOT COMPLETED THE HOME HEALTH (HH) UTILIZATION SECTION AND IF
THIS EVENT IS NOT PART OF A FLAT FEE GROUP, CONTINUE WITH HH17
OTHERWISE, GO TO BOX_04
23
Beta
Home Health (HH) Section
HH17
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
I have recorded that (PERSON) received services from (PROVIDER) during
other months. Were the services received from (PROVIDER) during the other
months similar to the services received during (VISIT MONTH). That is, in the
other
months,
did
(PROVIDER)
visit
{the
same
number
of
times/(READ
FREQUENCY BELOW)} and provide {the same services/(READ SERVICES
BELOW)}?
FREQUENCY SERVICES
{FREQUENCY OF SERVICES} {DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
Size
Variable Name
Label
HVIS.SAMESVCE
2
ANY OTHER MONTHS PER RECEIVED SERVICES
1
YES
{HH18}
2
NO
{BOX_04}
RF
Refused
{BOX_04}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_04}
24
Beta
Home Health (HH) Section
DISPLAY INSTRUCTIONS:
DISPLAY ‘the same number of times’ IF HH12 AND HH13 WERE NOT
ASKED OR WERE CODED 'RF' (REFUSED) OR 'DK' (DON’T KNOW).
OTHERWISE, DISPLAY ‘(READ FREQUENCY BELOW)’.
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY
‘the same services’. OTHERWISE, DISPLAY ‘(READ SERVICES
BELOW)’.
FREQUENCY =
DISPLAY NUMBER AND ‘DAYS PER WEEK’ IF A RESPONSE WAS RECORDED
AT HH12.
DISPLAY NUMBER AND ‘DAYS PER MONTH’ IF A RESPONSE WAS RECORDED
AT HH13.
DISPLAY ‘THE SAME NUMBER OF TIMES’ IF HH12 AND HH13 WERE NOT
ASKED OR WERE CODED 'RF' (REFUSED) OR 'DK' (DON’T KNOW).
SERVICES =
FOR EACH CODE 1 RECORDED AT HH06, HH07, HH08, HH09, AND HH10,
DISPLAY THE FOLLOWING SERVICE ABBREVIATIONS FOR ‘DESCRIPTION
OF SERVICE’:
IF HH06 = 1, DISPLAY ‘MEDICAL TREATMENT OR THERAPY’
IF HH07 = 1, DISPLAY ‘MEDICAL EQUIPMENT OR ASSISTIVE DEVICE
INSTRUCTION.’
IF HH08 = 1, DISPLAY ‘HELP WITH DAILY ACTIVITIES OR PERSONAL
CARE’
IF HH09 = 1, DISPLAY ’COMPANIONSHIP’
IF HH10 = 1, DISPLAY TEXT ENTERED AT HH10OV
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY
‘THE SAME SERVICES’.
25
Beta
Home Health (HH) Section
HH18
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Comment Enabled
Jump Back Enabled
Help Enabled
During which of the following months did (PROVIDER) visit {the same number
of times/(READ FREQUENCY BELOW)} and provide {the same services/
(READ SERVICES BELOW)}?
PROBE: Any other months with the same number of visits and the same
services?
FREQUENCY SERVICES
{FREQUENCY OF SERVICES} {DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
{DESCRIPTION OF SERVICES RECEIVED}
Size
Variable Name
Label
EVNT.HH18BLSWVS
EVNT.RVTYPE
2
REPEAT VISIT TYPE - STEM/LEAF
EVNT.RVSTEM
4
4-DIGIT EVENT NUMBER OF STEM RV
EVNT.PROCFLAG
2
EVNT UTILIZATION PROCESS FLAG
EVNT.STOREVAR
2
MATRIX TEMPORARY STORAGE VARIABLE
CLNK.CLNKID
24
CLNK ID KEY: CONDID + EVNTID
CLNK.CLNKRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
CLNK.CREATEQ
4
QUESTION THAT CREATED CLNK SEGMENT
CLNK.CLNKTYPE
2
TYPE OF EVENT CONDITION IS LINKED TO
EVPV.RVTYPE
2
REPEAT VISIT TYPE - STEM/LEAF
EVPV.RVSTEM
4
4-DIGIT EVENT NUMBER OF STEM RV
EVPV.CPFLAG
2
CHARGE PAYMENT PROCESS FLAG
HVIS.HVISID
12
HVIS ID KEY: PERSID + COUNTER(3) + CD
HVIS.HVISRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
HVIS.CREATEQ
2
CREATION STAMP
[Month, Year]
[Month, Year]
[Month, Year]
{HH19}
26
Beta
Home Health (HH) Section
DISPLAY INSTRUCTIONS:
DISPLAY ‘the same number of times’ IF HH12 AND HH13 WERE NOT
ASKED OR WERE CODED 'RF' (REFUSED) OR 'DK' (DON’T KNOW).
OTHERWISE, DISPLAY ‘(READ FREQUENCY BELOW)’.
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY
‘the same services’. OTHERWISE, DISPLAY ‘(READ SERVICES
BELOW)’.
FREQUENCY =
DISPLAY NUMBER AND ‘DAYS PER WEEK’ IF A RESPONSE WAS RECORDED
AT HH12.
DISPLAY NUMBER AND ‘DAYS PER MONTH’ IF A RESPONSE WAS RECORDED
AT HH13.
DISPLAY ‘THE SAME NUMBER OF TIMES’ IF HH12 AND HH13 WERE NOT
ASKED OR WERE CODED 'RF' (REFUSED) OR 'DK' (DON’T KNOW).
SERVICES =
FOR EACH CODE 1 RECORDED AT HH06, HH07, HH08, HH09, AND HH10,
DISPLAY THE FOLLOWING SERVICE ABBREVIATIONS FOR ‘DESCRIPTION
OF SERVICE’:
IF HH06 = 1, DISPLAY ‘MEDICAL TREATMENT OR THERAPY’
IF HH07 = 1, DISPLAY ‘MEDICAL EQUIPMENT OR ASSISTIVE DEVICE
INSTRUCTION.’
IF HH08 = 1, DISPLAY ‘HELP WITH DAILY ACTIVITIES OR PERSONAL
CARE’
IF HH09 = 1, DISPLAY -’COMPANIONSHIP’
IF HH10 = 1, DISPLAY TEXT ENTERED AT HH10OV
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY
‘THE SAME SERVICES’.
PROGRAMMER NOTES:
FLAG EACH MONTH SELECTED AT HH18 AS A REPEAT VISIT RELATED TO
THE EVENT BEING ASKED ABOUT. FLAG THE CHARGE PAYMENT
(CP)STATUS OF EACH REPEAT VISIT AS ‘PROCESSED.’
LINK FREQUENCY AND SERVICE(S) ASSOCIATED WITH THE EVENT BEING
ASKED ABOUT WITH EACH REPEAT VISIT. FLAG EVENT AS PROCESSED
SO THAT THE EVENT DRIVER WILL NOT SERVE THESE REPEAT VISITS
FOR THE HH SECTION.
Title:
PERS_MED_EVNT_1
Roster Details
Col #
Header
Instructions
1
DATE
Display the Month, Day, and Year of Medical Evnts
EVNT.EVNTBEGM, EVNT.EVNTBEGD,
EVNT.EVNTBEGY
27
Beta
Home Health (HH) Section
Roster Behavior:
1.Multiple Select allowed.
2.Add, delete, and edit disallowed.
Roster Filter:
Display all events (dates) in person’s medical events roster
that meet the following criteria:
- Created this round, excluding the interview month
- Have not been processed through utilization
- Have event type ‘HH’
- Are associated with the same provider as the event being
asked about during this round
Roster Definition:
Display the Person’s Medical Events Roster for selection.
28
Beta
Home Health (HH) Section
HH19
INTERVIEWER: RECORD ‘NAME OF REPEAT VISIT GROUP’ FOR
MONTHS 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
EVNT.RVNAME
30
NAME OF REPEAT VISIT GROUP
EVPV.RVNAME
30
NAME OF REPEAT VISIT GROUP
{BOX_04}
_______________________
BOX_04
IF THE CHARGE/PAYMENT (CP) SECTION IS NOT COMPLETED FOR THIS HOME HEALTH
EVENT, ASK THE CHARGE/PAYMENT (CP) SECTION
OTHERWISE, CONTINUE WITH BOX_05
BOX_05
GO TO THE EVENT DRIVER (ED) SECTION
29
| File Type | application/pdf |
| File Title | C:\HH (BETA).snp |
| Author | miller_n |
| File Modified | 2005-08-10 |
| File Created | 2005-08-10 |