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Form Version:
9/15/2017 1:19:51 PM
Report Type:
Full Detail
Project Database:
Language:
English
WESSQL6.MEPS_V2
Spec Label:
This is the cover page. Additional contents currently project specific.
ER - Page 1 of 12
MEPS_V2
Emergency Room (ER) Section
(Rout
Full Detail Spec
BOX_00
Route Details:
(ER1000)
Item Type: Route
Type Class: If Then
01 Box = BOX_00, BOX_10, BOX_20
04 S ingle S elect = ER20, ER40, ER60
06 S ingle S elect with Fill in Answer Text = ER10
08 Multiple S elect = ER50
11 Multiple S elect with Add/Edit/Delete = ER30, ER70
Roster 3 = ER30, ER70
BOX_10
Route Details:
(ER1001)
Item Type: Route
Type Class: If Then
Context header display instructions:
Display PERS .FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM,
EVNT.EVNTBEGD, EVNT.EVNTBEGY.
ER - Page 2 of 12
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
ER10
Item Type:
Type Class:
Answer Type:
(ER1010)
Question
Enumerated
TERVSTCATER02
Help Available (ERVstCatHelp)
Context Header:
BLAISE NAME: ERVstCat
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (ER-1)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
&ER-1.
Please look at card ER-1 and tell me which category best describes the care {you/{PERSON}} received during the visit to
{PROVIDER} emergency room on {VISIT DATE}.
HELP: F1
Responses:
Display
Instructions:
Testing/Editing
Notes:
DIAGNOSIS OR TREATMENT
EMERGENCY (E.G., ACCIDENT OR
INJURY)
PSYCHOTHERAPY OR MENTAL
HEALTH COUNSELING
FOLLOW-UP OR POST-OPERATIVE VISIT
IMMUNIZATIONS OR SHOTS
{PREGNANCY-RELATED (INCLUDING
PRENATAL CARE AND DELIVERY)}
OTHER
REFUSED
DON'T KNOW
1
2
ER20
ER20
(ER1015)
(ER1015)
3
ER20
(ER1015)
4
5
6
ER20
ER20
ER20
(ER1015)
(ER1015)
(ER1015)
91
RF
DK
ER20
ER20
ER20
(ER1015)
(ER1015)
(ER1015)
Display response option ‘6’ (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND
DELIVERY) ), if person is female and age 15 to 55 inclusive (or age categories 3 to 8).
Otherwise, use a null display.
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER - Page 3 of 12
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
ER20
Item Type:
Type Class:
Answer Type:
Help Available (
Context Header:
(ER1015)
Question
Enumerated
TYESNO
)
BLAISE NAME: ERSpecCond
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
Was this visit related to any specific health condition or were any conditions discovered during this visit?
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER - Page 4 of 12
ER30
ER40
ER40
ER40
(ER1020)
(ER1023)
(ER1023)
(ER1023)
)
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
ER30
Item Type:
Type Class:
Answer Type:
(ER1020)
Question
Enumerated
TCONDITION
BLAISE NAME: ERCondRoster
Field kind: Datafield
Field Size:
Answers allowed: 99 ArrayMax:
Help Available (CondHelp)
Context Header:
ArrayMin:
Show Card (
)
Min value:
Max value:
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
What conditions were discovered or led {you/{PERSON}} to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1
Responses:
{MEDICAL CONDITION} 1
{MEDICAL CONDITION} 2
{MEDICAL CONDITION} 3
{MEDICAL CONDITION} 4
{MEDICAL CONDITION}N
1
2
3
4
5
ER - Page 5 of 12
ER50
ER50
ER50
ER50
ER50
(ER1025)
(ER1025)
(ER1025)
(ER1025)
(ER1025)
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
Programmer
Instructions:
Display
Instructions:
Roster behavior:
1. Multiple select allowed.
2. Multiple add allowed.
3. Limited delete allowed. Interviewer may delete a condition added at this item until CAPI
creates the link between this condition and the event. The link is created when the collection
of utilization and/or charge/payment data is complete.
4. Limited edit allowed. Interviewer may edit a condition name newly added at this item until
CAPI creates the link between this condition and the event. The link is created when the
collection of utilization and/or charge/payment data is complete.
Roster 3 – add/edit/delete allowed
Roster definition:
Display the person-medical-conditions-roster for the selection and addition of one or many medical
condition(s) associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; no filter.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER40
Item Type:
Type Class:
(ER1023)
Question
Enumerated
Answer Type:
TYESNO
Help Available (SurgProcHelp)
Context Header:
BLAISE NAME: ERSurgProc
Field kind: Datafield
Field Size:
Answers allowed: 1
ArrayMin:
Min value:
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
Was a surgical procedure performed on {you/{PERSON}} during this visit?
HELP: F1.
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
ER - Page 6 of 12
ER50
ER50
ER50
ER50
(ER1025)
(ER1025)
(ER1025)
(ER1025)
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER50
Item Type:
(ER1025)
Question
Type Class:
Enumerated
Answer Type:
TMEDSVCTYPE
Help Available (MedServHelp)
Context Header:
BLAISE NAME: CodeAllERSvc
Field kind: Datafield
ArrayMin:
Min value:
ArrayMax:
Max value:
Field Size:
Answers allowed: 7
Show Card (ER-2)
Look Up File (
)
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
&ER-2.
Looking at this card, which of these services, if any, did {you/{PERSON}} have during this visit?
ENTER ALL THAT APPLY.
HELP: F1.
Responses:
LABORATORY TESTS
SONOGRAM OR ULTRASOUND
X-RAYS
MAMMOGRAM
MRI OR CATSCAN
EKG, ECG, OR EEG
VACCINATION
NONE OF THESE SERVICES RECEIVED
REFUSED
DON'T KNOW
1
2
3
4
5
6
7
95
RF
DK
ER - Page 7 of 12
ER60
ER60
ER60
ER60
ER60
ER60
ER60
ER60
ER60
ER60
(ER1035)
(ER1035)
(ER1035)
(ER1035)
(ER1035)
(ER1035)
(ER1035)
(ER1035)
(ER1035)
(ER1035)
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
Programmer
Instructions:
Soft Check:
If coded ‘4’ (MAMMOGRAM) and person being asked about is male or is female and < or =
17 years of age (or age categories 1-3), display the following message: “UNLIKELY
RESPONSE FOR {MALES/CHILDREN 17 AND YOUNGER}. VERIFY AND REENTER.”
Display ‘MALE’ in error message if person being asked about is a male > 17 years of age (or
age categories 4 through 9). Display ‘CHILDREN 17 AND YOUNGER’ in the error
message if person being asked about is male or female and < or = 17 years of age (or age
categories 1-3).
Allow code '95' (NONE OF THESE SERVICES RECEIVED) , 'RF' (REFUSED), and 'DK'
(DON'T KNOW)
alone only; these responses may not be selected with any other response.
Note: 'NONE OF THESE SERVICES RECEIVED' is not displayed on show card.
Hard check:
Edit: if coded ‘95’ (NONE OF THESE SERVICES RECEIVED), no other service categories
can be coded.
If interviewer selects another code with NONE OF THESE SERVICES RECEIVED, display
the following message: "NONE OF THESE SERVICES RECEIVED CANNOT BE
SELECTED WITH OTHER OPTIONS. VERIFY AND RE- ENTER."
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER - Page 8 of 12
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
ER60
Item Type:
Type Class:
Answer Type:
(ER1035)
Question
Enumerated
TYESNO
Help Available (MEDPRESHelp)
Context Header:
BLAISE NAME: ERPmed
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
During this visit, were any medicines prescribed for {you/{PERSON}}? Please include only prescriptions which were filled.
HELP: F1
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER - Page 9 of 12
ER70
BOX_20
BOX_20
BOX_20
(ER1040)
(ER1045)
(ER1045)
(ER1045)
MEPS_V2
Emergency Room (ER) Section
(Que
Full Detail Spec
ER70
Item Type:
Type Class:
Answer Type:
Help Available (
Context Header:
(ER1040)
Question
Enumerated
BLAISE NAME: ERPmedRoster
Field kind: Datafield
ArrayMin:
Field Size:
TPRESCRIBEDMED Answers allowed: 99 ArrayMax:
)
Show Card (
Min value:
Max value:
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Question Text:
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?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
Responses:
{PRESCRIBED MEDICINE}1
{PRESCRIBED MEDICINE}2
{PRESCRIBED MEDICINE}3
{PRESCRIBED MEDICINE}4
{PRESCRIBED MEDICINE}N
1
2
3
4
5
ER - Page 10 of 12
BOX_20
BOX_20
BOX_20
BOX_20
BOX_20
(ER1045)
(ER1045)
(ER1045)
(ER1045)
(ER1045)
MEPS_V2
Full Detail Spec
Programmer
Instructions:
Emergency Room (ER) Section
(Que
Roster behavior:
1. Multiple select allowed.
2. Multiple add allowed.
3. Limited delete allowed. Interviewer may delete a medicine added at this item until CAPI
creates the link between this medicine and the event. The link is created when the collection
of utilization and/or charge/payment data is complete.
4. Limited edit allowed. Interviewer may edit medicines added at this item until CAPI creates
the link between this medicine and the event. The link is created when the collection of
utilization and/or charge/payment data is complete.
NOTE: In order for the columns to display properly, 35 allowable characters for the
medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be
allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60
characters for the medicine name.
General flag rules for medicines:
- Round medicine first created (by definition a medicine is selected the same time it is
created)
- Question number medicine first created
- Round medicine selected
- Event medicine is linked to (however, this is known by virtue that the medicine was
selected at ER70 for this event)
Display
Instructions:
Roster 3 – add/edit/delete allowed
Roster definition:
This item displays the person’s-prescription medicines-roster for selection. Display name of prescribed
medicine (DRUG.DRUGNAME).
Roster filter:
Display all medicines on person's roster; no filter.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.ER_Main
Variable stored at MEPSSpring2018_Event.ER_Main
ER - Page 11 of 12
MEPS_V2
Emergency Room (ER) Section
(Rout
Full Detail Spec
BOX_20
Route Details:
(ER1045)
Item Type: Route
Type Class: If Then
Go to the Charge/Payment (CP) section if it needs to be asked for this emergency
room event, i.e. its status wasn’t set to ‘Completed’ because it was part of a Flat Fee
situation where the charges were collected in the CP section for another event in that
Flat Fee group.
Otherwise, go to the event driver (ED) section.
[End of ER]
ER - Page 12 of 12
File Type | application/pdf |
File Modified | 2018-02-21 |
File Created | 2017-09-15 |