/* SHORT TITLE: Codebook for Patient Quest-Dental, T1-T6 */
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* W E S T A T C O D E B O O K *
* ----------- --------------- *
* *
* STUDY OF HEALTH CARE COSTS *
* DENTAL RECORD *
* 30 JUNE 1994 *
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* W E S T A T C O D E B O O K *
* ----------- --------------- *
* *
* STUDY OF HEALTH CARE COSTS *
* DENTAL RECORD *
* 30 JUNE 1994 *
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(0)
27 Jun. 1994
Record 01
STUDY OF HEALTH CARE COSTS
DENTAL RECORD
30 JUNE 1994
Question Column
Name Number(s)
________ _________
PATID 001-009 PATIENT ID
__________
000000001-
999999999 = RANDOMLY ASSIGNED SEQUENTIAL NUMBER
REC01 010-011 RECORD NUMBER
_____________
01 = RECORD NUMBER
SUBREC 012-013 SUBRECORD NUMBER
________________
01-99 = SUBRECORD NUMBER
SFORM 014 QUESTIONNAIRE TYPE
__________________
A = TIME 1 ADULT QUESTIONNAIRE
B = TIME 2 ADULT QUESTIONNAIRE
C = TIME 3 ADULT QUESTIONNAIRE
G = TIME 4 ADULT QUESTIONNAIRE
H = TIME 5 ADULT QUESTIONNAIRE
I = TIME 6 ADULT QUESTIONNAIRE
D = TIME 1 PEDIATRIC QUESTIONNAIRE
E = TIME 2 PEDIATRIC QUESTIONNAIRE
F = TIME 3 PEDIATRIC QUESTIONNAIRE
J = TIME 4 PEDIATRIC QUESTIONNAIRE
K = TIME 5 PEDIATRIC QUESTIONNAIRE
L = TIME 6 PEDIATRIC QUESTIONNAIRE
SFPART 015-016 QUESTIONNAIRE QUESTION
______________________
I1 = DENTAL VISITS
PLEASE REFER TO YOUR ANNOTATED QUESTIONNAIRES. THIS RECORD WAS CHANGED ACROSS TIMES IN
SUCH A WAY THAT IT MAKES IT DIFFICULT TO CLEARLY DOCUMENT THE SKIP PATTERNS.
(1)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
VISITDAT (017-022) WHAT (WAS/WERE) THE DATE(S) OF (THAT/THOSE) VISIT(S)?
______________________________________________________
CODER: IF VISITYR EQUALS 97, 98 OR 99, CODE 99 IN VISITMO AND VISITDY.
VISITMO 017-018 MONTH OF VISIT
______________
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
VISITDY 019-020 DAY OF VISIT
____________
01-31 = DAY
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
VISITYR 021-022 YEAR OF VISIT
_____________
91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
DENTREAS (023-033) (FIRST/NOW) I WILL ASK YOU ABOUT YOUR VISIT ON (DATE). PLEASE TELL ME WHICH OF THESE
SERVICES YOU RECEIVED AT THIS VISIT (CODE ALL THAT APPLY.)
__________________________________________________________
CODER: AT LEAST ONE ITEM MUST BE CIRCLED. IF NONE ARE CIRCLED, CODE 9 FOR EACH ITEM.
IF AT LEAST ONE ITEM IS CIRCLED, CODE 1 FOR EASCH CIRCLED ITEM(S). CODE 2 FOR ALL
UNCIRCLED ITEM(S).
(2)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
EXAM 023 EXAMINATION/LABWORK
___________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CLEAN 024 CLEANING TEETH/SCALING
______________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
XRAY 025 XRAYS
_____
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
FILL 026 FILLINGS
________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
EXTRC 027 EXTRACTIONS
___________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(3)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
ROOT 028 ROOT CANAL
__________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
DENTURE 029 CROWN/BRIDGE OR DENTURE WORK/IMPLANT/CAPS
_________________________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GUM 030 GUM CARE
________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
OTH 031 OTHER
_____
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(4)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
OTHS 032-033 OTHER SPECIFIED REASON FOR DENTAL VISIT
_______________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN OTH.
09 = ORAL SURGERY
12 = FLUORIDE RINSE/MEDICATION/MEDICINE/INJECTED NOVACAINE
15 = BRACES
19 = BONDING ON TEETH
21 = TREATMENT PLAN/CONSULTATION/REFERRAL/MEDICAL HISTORY
22 = BIOPSY
25 = DENTAL APPLIANCE
26 = PULP TREATMENT
27 = ULCER TREATMENT
28 = CANDIDIASIS FUNGUS/THRUSH
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
SORES 034 HAVE YOU BEEN TREATED FOR ANY SORES IN THE MOUTH, THRUSH OR OTHER?
___________________________________________________________________
+ = INAPPLICABLE, CODED A, B, D OR E IN SFORM
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
RECBILL 035 NOW I'D LIKE TO ASK YOU ABOUT THE CHARGES FOR THIS VISIT TO THE DENTIST. HAVE YOU
RECEIVED ANY BILL OR STATEMENT FOR THIS VISIT ON (DATE)?
_________________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
EXPBILL 036 DO YOU EXPECT TO RECEIVE A BILL OR STATEMENT FOR THIS VISIT?
_____________________________________________________________
+ = INAPPLICABLE, CODED 1 IN RECBILL.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(5)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
WHY 037-038 WHY IS THAT?
_____________
+ = INAPPLICABLE, CODED 1 IN RECBILL; OR CODED 1 IN EXPBILL.
01 = PAID IN FULL
02 = DIRECT BILLED TO INSURANCE
03 = PREPAID PLAN
04 = INCLUDED WITH OTHER CHARGES
05 = WELFARE/MEDICAID
06 = FREE FROM PROVIDER
07 = RESEARCH STUDY
08 = DONATION/SLIDING SCALE
09 = FLAT FEE CHARGES FROM PREVIOUS VISIT
10 = PRIVATE CHARITY
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
NUMINCLD 039-040 YOU MENTIONED YOU HAD (NUMBER) DENTAL VISITS. WE HAVE ALREADY TALKED ABOUT (NUMBER) OF
THESE VISITS. HOW MANY OF THE REMAINING VISITS WERE INCLUDED IN THIS CHARGE?
______________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN RECBILL; OR CODED 1 IN EXPBILL; OR CODED 1, 2,
3, 5-10, 97, 98 OR 99 IN WHY.
00 = NONE
01-20 = NUMBER OF VISITS INCLUDED IN CHARGE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BOX 1: IF SFORM NOT EQUAL A OR D THEN IF TOTAL CHARGE FOR THIS SERIES OF VISITS HAS BEEN
ACCOUNTED FOR, SKIP KNOWCHRG -OPCPY.
KNOWCHRG 041 DO YOU KNOW WHAT THE TOTAL CHARGE WAS FOR THIS VISIT?
______________________________________________________
+ = INAPPLICABLE, CODED ONLY IF SFPART NOT = A OR D; OR EXPBILL = 1; OR WHY =
02, 03 OR 98.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(6)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
TOTCHRG 042-047 INCLUDING ANY AMOUNTS THAT MAY BE PAID BY HEALTH INSURANCE, MEDICARE, MEDICAID, OR OTHER
SOURCES, HOW MUCH WAS THE TOTAL CHARGE FOR THIS VISIT ON (DATE)? (IF THE BILL SEPARATELY
LISTED CHARGES FOR PROCEDURES SUCH AS X-RAYS, INCLUDE THOSE CHARGES IN THE TOTAL.)
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10, 91 IN WHY; OR TOTAL CHARGE FOR THIS SERIES HAS
BEEN RECORDED.
000000 = NOTHING
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
SPD (048-056) SINCE (DATE), HOW MUCH OF THE TOTAL CHARGE HAVE YOU PAID?
__________________________________________________________
CODER: ONE OR THE OTHER ($/%) WILL BE CODED.
SPDDOL 048-053 DOLLAR AMOUNT PAID
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED PERCENT PAID IN SPDPC.
000000 = NOTHING
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
(7)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
SPDPC 054-056 PERCENT PAID
____________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED DOLLAR AMOUNT OR 7, 8 OR 9 IN
SPDDOL.
000 = NOTHING
001-100 = PERCENT
BOX 2: IF NOTHING PAID; I.E. SPDPC = 0 OR SPDDOL = 0, THEN SKIP REIMBUR1-RPC1.
REIMBUR1 057 HAS ANY SOURCE REIMBURSED OR PAID YOU BACK ANYTHING FOR THE AMOUNT YOU PAID?
_____________________________________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
RWHO1 058-060 WHO REIMBURSED OR PAID YOU BACK?
_________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR1.
001 = INSURANCE COMPANY/DENTAL PLAN
002 = UNION
003 = PUBLIC ASSISTANCE, INCLUDED MEDICARE/MEDICAID ETC
004 = PRIVATE CHARITY
005 = FAMILY
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
RPD (061-069) HOW MUCH DID (SOURCE) REIMBURSE OR PAY YOU BACK?
CODER: ONE OR THE OTHER ($/%) WILL BE USED.
(8)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
RDOL1 061-066 DOLLAR AMOUNT PAID
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR1. OR
CODED PERCENT IN RPC1
000000 = NOTHING
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
RPC1 067-069 PERCENT PAID
____________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR1; OR
CODED DOLLAR AMOUNT IN RDOL1.
001-100 = PERCENT
REIMBUR2 070 DO YOU EXPECT ANY (OTHER) SOURCE TO REIMBURSE YOU FOR WHAT YOU PAID?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR1.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
RWHO2 071-073 WHO DO YOU EXPECT TO REIMBURSE OR PAY YOU BACK?
________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR2; OR
NOT CODED A OR D IN SFORM.
001 = INSURANCE COMPANY/DENTAL PLAN
002 = UNION
003 = PUBLIC ASSISTANCE, INCLUDED MEDICARE/MEDICAID ETC
004 = PRIVATE CHARITY
005 = FAMILY
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(9)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PPY (074-082) HOW MUCH DO YOU EXPECT TO BE REIMBURSED OR PAID BACK?
CODER: ONE OR THE OTHER ($/%) WILL BE CODED.
RDOL2 074-079 DOLLAR AMOUNT PAID
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR2 OR
CODED % IN RPC2; OR NOT CODED A OR D IN SFORM.
000000-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
RPC2 080-082 PERCENT PAID
____________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN REIMBUR2; OR
CODED DOLLAR AMOUNT IN RDOL2; OR NOT CODED A OR D IN SFORM.
001-100 = PERCENT
BOX 3: IF TOTAL CHARGE HAS BEEN PAID; I.E. SPDPC = 100% OR SPDDOL = TOTCHRG, THEN SKIP
SPAY-OPCPY.
SPAY 083 DO YOU EXPECT TO PAY ANY (ADDITIONAL) AMOUNT FOR THIS VISIT?
_____________________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(10)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
SPY (084-092) HOW MUCH?
CODER: ONE OR THE OTHER ($/%) WILL BE CODED.
SDOL2 084-089 DOLLAR AMOUNT PAID
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN SPAY. OR
CODED % IN SPC2.
000000-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
SPC2 090-092 PERCENT PAID
____________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN SPAY; OR CODED
DOLLAR AMOUNT IN SDOL2.
001-100 = PERCENT
OTHPAID 093 HAVE ANY (OTHER) SOURCES ALREADY PAID ANY OF THE CHARGES FOR THIS VISIT?
_________________________________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY;
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(11)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
OWHOPD 094-096 WHO (ELSE) PAID?
_________________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN OTHPAID.
001 = INSURANCE COMPANY/DENTAL PLAN
002 = UNION
003 = PUBLIC ASSISTANCE, INCLUDED MEDICARE/MEDICAID ETC
004 = PRIVATE CHARITY
005 = FAMILY
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
OPD (097-105) HOW MUCH DID (SOURCE) PAY?
CODER: ONE OR THE OTHER ($/%) WILL BE USED.
ODOLPD 097-102 DOLLAR AMOUNT PAID
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN OTHPAID; OR
CODED % IN OPCD.
000000-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
OPCD 103-105 PERCENT PAID
____________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN OTHPAID; OR
CODED DOLLAR AMOUNT IN ODOLPD
001-100 = PERCENT
BOX 4: IF SFORM NOT = A OR D, THEN IF TOTAL AMOUNT HAS BEEN PAID OR OR ACCOUNTED FOR,
THEN SKIP OTHPAY-OPCPY.
(12)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
OTHPAY 106 DO YOU EXPECT ANYONE ELSE TO PAY ANY OF THE CHARGES FOR THIS VISIT?
____________________________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY;
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
OWHOPY 107-109 WHAT SOURCES DO YOU EXPECT TO PAY FOR THIS VISIT?
__________________________________________________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN OTHPAY.
001 = INSURANCE COMPANY/DENTAL PLAN
002 = UNION
003 = PUBLIC ASSISTANCE, INCLUDED MEDICARE/MEDICAID ETC
004 = PRIVATE CHARITY
005 = FAMILY
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
OPY (110-118) HOW MUCH DO YOU EXPECT (SOURCE) TO PAY?
CODER: ONE OR THE OTHER ($/%) WILL BE USED.
ODOLPY 110-115 DOLLAR AMOUNT PAID
CODER: CODE AMOUNTS IN WHOLE NUMBERS.
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN OTHPAY; OR
CODED % IN OPCPY.
000000-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
(13)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
OPCPY 116-118 PERCENT PAID
____________
+ = INAPPLICABLE, CODED 05-10 IN WHY; OR CODED 2, 7, 8 OR 9 IN OTHPAY; OR
DOLLAR AMOUNT CODED IN ODOLPY.
001-100 = PERCENT
(14)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
INDEX OF VARIABLES PAGE 001
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CLEAN 024 Record 01 003
===== D =====
DENTREAS (023-033) Record 01 002
DENTURE 029 Record 01 004
===== E =====
EXAM 023 Record 01 003
EXPBILL 036 Record 01 005
EXTRC 027 Record 01 003
===== F =====
FILL 026 Record 01 003
===== G =====
GUM 030 Record 01 004
===== K =====
KNOWCHRG 041 Record 01 006
===== N =====
NUMINCLD 039-040 Record 01 006
===== O =====
ODOLPD 097-102 Record 01 012
ODOLPY 110-115 Record 01 013
OPCD 103-105 Record 01 012
OPCPY 116-118 Record 01 014
OPD (097-105) Record 01 012
OPY (110-118) Record 01 013
OTH 031 Record 01 004
OTHPAID 093 Record 01 011
OTHPAY 106 Record 01 013
OTHS 032-033 Record 01 005
OWHOPD 094-096 Record 01 012
OWHOPY 107-109 Record 01 013
===== P =====
PATID 001-009 Record 01 001
INDEX OF VARIABLES PAGE 002
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== P =====
PPY (074-082) Record 01 010
===== R =====
RDOL1 061-066 Record 01 009
RDOL2 074-079 Record 01 010
RECBILL 035 Record 01 005
REC01 010-011 Record 01 001
REIMBUR1 057 Record 01 008
REIMBUR2 070 Record 01 009
ROOT 028 Record 01 004
RPC1 067-069 Record 01 009
RPC2 080-082 Record 01 010
RPD (061-069) Record 01 008
RWHO1 058-060 Record 01 008
RWHO2 071-073 Record 01 009
===== S =====
SDOL2 084-089 Record 01 011
SFORM 014 Record 01 001
SFPART 015-016 Record 01 001
SORES 034 Record 01 005
SPAY 083 Record 01 010
SPC2 090-092 Record 01 011
SPD (048-056) Record 01 007
SPDDOL 048-053 Record 01 007
SPDPC 054-056 Record 01 008
SPY (084-092) Record 01 011
SUBREC 012-013 Record 01 001
===== T =====
TOTCHRG 042-047 Record 01 007
===== V =====
VISITDAT (017-022) Record 01 002
VISITDY 019-020 Record 01 002
VISITMO 017-018 Record 01 002
VISITYR 021-022 Record 01 002
===== W =====
WHY 037-038 Record 01 006
INDEX OF VARIABLES PAGE 003
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== X =====
XRAY 025 Record 01 003