/* SHORT TITLE: Codebook for Patient Quest-Time 2 Specific Data */
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* W E S T A T C O D E B O O K *
* ----------- --------------- *
* *
* STUDY OF HEALTH CARE COSTS *
* WESTAT ADULT QUESTIONNAIRE TIME 2 - PUBLIC USE *
* 30 JUNE 1994 *
********************************************************************************
********************************************************************************
* W E S T A T C O D E B O O K *
* ----------- --------------- *
* *
* STUDY OF HEALTH CARE COSTS *
* WESTAT ADULT QUESTIONNAIRE TIME 2 - PUBLIC USE *
* 30 JUNE 1994 *
********************************************************************************
(0)
27 Jun. 1994
Record 01
STUDY OF HEALTH CARE COSTS
WESTAT ADULT QUESTIONNAIRE TIME 2 - PUBLIC USE
30 JUNE 1994
Question Column
Name Number(s)
________ _________
BPID01 001-009 PATIENT ID NUMBER
_________________
000000001-
999999999 = RANDOMLY ASSIGNED SEQUENTIAL NUMBER
BREC01 010-011 RECORD NUMBER
_____________
01 = NUMBER
BSREC01 012-013 SUBRECORD NUMBER
________________
00 = NOT A REPEATING RECORD
BITYPE 014 WHAT IS THE INSTRUMENT TYPE?
_____________________________
B = TIME 2 QUESTIONNAIRE
BRTYPE 015 RESPONDENT TYPE
_______________
1 = STUDY SUBJECT
2 = PROXY
BLANG 016 QUESTIONNAIRE LANGUAGE VERSION
______________________________
1 = ENGLISH
2 = SPANISH
BREFDT (017-022) BEGIN REFERENCE DATE
____________________
BREFMO 017-018 MONTH OF BEGIN REFERENCE DATE
_____________________________
01-12 = MONTH
(1)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BREFDY 019-020 DAY OF BEGIN REFERENCE DATE
___________________________
01-31 = DAY
BREFYR 021-022 YEAR OF BEGIN REFERENCE DATE
____________________________
91-92 = YEAR
BENDDT (023-028) REFERENCE END DATE
__________________
BENDMO 023-024 MONTH OF END DATE
_________________
01-12 = MONTH
BENDDY 025-026 DAY OF END DATE
_______________
01-31 = DAY
BENDYR 027-028 YEAR OF END DATE
________________
91-92 = YEAR
T2_STAT 029-030 QUESTIONNAIRE STATUS
____________________
CO = COMPLETE, WITH RESPONDENT
PR = COMPLETE, WITH PROXY
DD = COMPLETE, WITH PROXY PATIENT DECEASED AT TIME OF INTERVIEW
OBSDAYS2 031-033 OBSERVATION DAYS WITHIN REFERENCE PERIOD EXCLUDING PERIODS OF INELIGIBILITY
___________________________________________________________________________
001-600 = NUMBER
999 = NOT ASCERTAINED
(2)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
GAP2FLAG 034 PATIENT HAD TIME GAP DURING REFERENCE PERIOD
____________________________________________
+ = INAPPLICABLE, NO TIME GAP
1 = YES TIME GAP
ADM2 035-036 NUMBER OF INPATIENT ADMISSIONS (UNSTANDARDIZED)
_______________________________________________
00 = NONE
01-99 = NUMBER OF ADMISSIONS
IPNGT2 037-039 NUMBER OF INPATIENT NIGHTS (UNSTANDARDIZED)
___________________________________________
000 = NONE
001-999 = NUMBER OF NIGHTS
AMBVS2 040-042 NUMBER OF AMBULATORY VISITS, INCLUDES HOSPITAL CLINIC, OTHER CLINIC AND PRIVATE MD
(UNSTANDARDIZED)
________________
000 = NONE
001-999 = NUMBER OF AMBULATORY VISITS
ERVS2 043-045 NUMBER OF EMERGENCY ROOM VISITS (UNSTANDARDIZED)
________________________________________________
000 = NONE
001-999 = NUMBER OF EMERGENCY ROOM VISITS
HCVS2 046-048 NUMBER OF HOSPITAL CLINC VISITS (UNSTANDARDIZED)
________________________________________________
000 = NONE
001-999 = NUMBER OF HOSPITAL CLINIC VISITS
OCVS2 049-051 NUMBER OF OTHER CLINIC VISITS (UNSTANDARDIZED)
______________________________________________
000 = NONE
001-999 = NUMBER OF OTHER CLINIC VISITS
(3)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
MDVS2 052-054 NUMBER OF PRIVATE MD VISITS (UNSTANDARDIZED)
____________________________________________
000 = NONE
001-999 = NUMBER OF PRIVATE MD VISITS
BHSEHOLD (055) HOUSEHOLD COMPOSITION
_____________________
BA1 (055-120) PLEASE TELL ME THE FIRST NAMES OR INITIALS OF ALL THE PEOPLE WHO CURRENTLY LIVE WITH
(PATIENT) AND HOW THEY ARE RELATED TO (PATIENT). I'M GOING TO START BY LISTING (PATIENT)
ON THE GRID AND I'D LIKE TO GET (PATIENT'S) DATE OF BIRTH.
___________________________________________________________
PATIENT (055-058) IS (PATIENT) MALE OR FEMALE? WHAT IS (PATIENT'S) DATE OF BIRTH? HAS (PATIENT) BEEN
DIAGNOSED AS BEING HIV POSITIVE?
_________________________________
BA1RELP 055-056 RELATIONSHIP
____________
00 = RESPONDENT
BA1SEXP 057 IS (PATIENT) MALE OR FEMALE?
_____________________________
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1SSTP 058 HAS (PATIENT) BEEN DIAGNOSED AS BEING HIV POSITIVE?
____________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(4)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON1 (059-064) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL1 059-060 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX1 061 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE1 062-063 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST1 064 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(5)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON2 (065-070) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL2 065-066 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX2 067 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE2 068-069 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-94 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST2 070 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(6)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON3 (071-076) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL3 071-072 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX3 073 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE3 074-075 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-90 = YEARS
00 = NEWBORN TO 11 MONTHS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST3 076 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(7)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON4 (077-082) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL4 077-078 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX4 079 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE4 080-081 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST4 082 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(8)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON5 (083-088) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL5 083-084 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX5 085 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE5 086-087 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST5 088 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(9)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON6 (089-094) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL6 089-090 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX6 091 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE6 092-093 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST6 094 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(10)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON7 (095-100) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL7 095-096 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX7 097 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE7 098-099 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST7 100 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(11)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON8 (101-106) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL8 101-102 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX8 103 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE8 104-105 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST8 106 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(12)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON9 (107-112) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL9 107-108 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX9 109 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE9 110-111 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST9 112 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(13)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
PERSON10 (113-118) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (NAME) MALE OR FEMALE? HOW OLD IS (NAME)?
________________________________________________________________________________________
BA1REL10 113-114 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SEX10 115 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA1AGE10 116-117 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
00 = NEWBORN TO 11 MONTHS
01-90 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA1SST10 118 HAS (NAME) BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(14)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA1CT 119-120 NUMBER OF PEOPLE LISTED IN HOUSE HOLD
_____________________________________
01-17 = NUMBER
BABOXA1 (121-123) BOX A -1
BABOXA1A 121 R LIVES ALONE?
_______________
1 = YES
2 = NO
BABOXA1B 122 CHILDREN LISTED?
_________________
1 = YES
2 = NO
BABOXA1C 123 SPOUSE/PARTNER LISTED?
_______________________
* 1 = YES
2 = NO
* SKIP BA2 - BA4
BA2 124 ARE YOU CURRENTLY LEGALLY MARRIED, WIDOWED, DIVORCED, SEPARATED, OR HAVE YOU NEVER BEEN
MARRIED?
_________
+ = INAPPLICABLE, CODED 1 IN BABOXA1C.
* 1 = MARRIED
2 = WIDOWED
3 = DIVORCED
4 = SEPARATED
5 = NEVER MARRIED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BA3
(15)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA3 125 ARE YOU CURRENTLY INVOLVED IN A COMMITTED RELATIONSHIP WITH ONE OTHER PERSON?
______________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BABOXA1C; OR CODED 1 IN BA2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BA4
BA4 126 HAS (YOUR SPOUSE/THAT PERSON) ALSO BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BABOXA1C; OR CODED 2, 7, 8 OR 9 IN BA3.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA5 127-128 PLEASE LOOK AT THIS CARD, WHICH DESCRIBES DIFFERENT TYPES OF PLACES WHERE PEOPLE LIVE.
SINCE (REF. DATE) IN WHICH ONE OF THESE TYPES OF PLACES DID YOU LIVE MOST OF THE TIME?
CODE ONE.
__________
CODER: IF "SPECIALIZED" AIDS HOUSING IS CIRCLED IN Q.A5 OR Q.A6, CODE Q.A7 -Q.A13. IF
NOT, GO TO SECTION B.
01 = APARTMENT OR HOUSE WHICH YOU OWN OR HOLD THE LEASE
02 = APARTMENT OR HOUSE OF ANOTHER IN WHICH YOU PAY RENT BUT DON'T HOLD THE
LEASE
03 = "DOUBLED UP" WITH FRIEND OR RELATIVE ON SOFA, FLOOR, ETC
04 = SINGLE ROOM ONLY (SRO) OR 'WELFARE HOTEL'
05 = SPECIALIZED AIDS HOUSING
06 = SHELTERS
07 = STREET OR OTHER PUBLIC PLACE
08 = HOSPITAL/NURSING HOME/RESIDENTIAL CARE FACILITY/DRUG REHAB CTR
09 = IN FOSTER HOMES
10 = LIVES WITH SOMEONE ELSE
11 = JAIL
12 = PUBLIC HOUSING
13 = TRAILER/HOUSE LINK OWNED/LEASED
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(16)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA6 (129-134) PLEASE LOOK AT THIS CARD. SINCE (REF. DATE) DID YOU LIVE IN ANY OF THESE PLACES OR
SITUATIONS? (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 IS CIRCLED, CODE 1 FOR ALL CIRCLED ITEM(S). CODE 2 FOR ALL UNCIRCLED
ITEM(S).
BA6A 129 TEMPORARILY "DOUBLED UP" WITH FRIEND OR RELATIVE ON SOFA, FLOOR, ETC
____________________________________________________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA6B 130 SINGLE ROOM ONLY (SRO) OR "WELFARE HOTEL"
_________________________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA6C 131 SPECIALIZED AIDS HOUSING
________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA6D 132 SHELTERS
________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(17)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA6E 133 STREET OR OTHER PUBLIC PLACE
____________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA6F 134 NONE
____
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA7 (135-138) YOU SAID YOU'VE LIVED IN SPECIALIZED AIDS HOUSING SINCE (REF. DATE). ON WHAT DATE DID
YOU START LIVING THERE?
CODER: IF BA7YR EQUALS 97, 98 OR 99, CODE 99 IN BA7MO.
BA7MO 135-136 WHAT MONTH DID YOU START LIVING IN SPECIALIZED AIDS HOUSING?
_____________________________________________________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA7YR 137-138 WHAT YEAR DID YOU START LIVING IN SPECIALIZED AIDS HOUSING?
____________________________________________________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C.
85-91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(18)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA8 (139-142) ON WHAT DATE DID YOU LEAVE?
____________________________
BA8MO 139-140 IN WHAT MONTH DID YOU LEAVE?
_____________________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C
01-12 = MONTH
95 = STILL LIVING THERE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA8YR 141-142 IN WHAT YEAR DID YOU LEAVE?
____________________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C
85-91 = YEAR
95 = STILL LIVING THERE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BA9PROV 143-149 PROVIDER ID
___________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8 OR 9 IN BA6C.
0000001-
9999996 = RANDOMLY ASSIGNED SEQUENTIAL NUMBER
9999997 = REFUSED
9999998 = DK
9999999 = NOT ASCERTAINED
(19)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA10 150-155 HOW MUCH DID OR WILL YOU PAY FOR THIS HOUSING?
CODER: CODE AMOUNTS IN WHOLE DOLLARS
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C.
000000 = NOTHING
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BA11 156 IS SOMEONE ELSE PAYING (AN ADDITIONAL AMOUNT) FOR THIS STAY?
_____________________________________________________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BA12A - BA12EOS
BA12 (157-163) WHO ELSE IS PAYING FOR THIS STAY? 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 IS CIRCLED, CODE 1 FOR ALL CIRCLED ITEM(S). CODE 2 FOR ALL UNCIRCLED
ITEM(S).
(20)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA12A 157 MEDICAID
________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 2, 7, 8 OR 9 IN
BA11.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA12B 158 OTHER PUBLIC ASSISTANCE
_______________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 2, 7, 8 OR 9 IN
BA11.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA12C 159 PRIVATE INSURANCE
_________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 2, 7, 8 OR 9 IN
BA11.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BA12D 160 MEDICARE
________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 2, 7, 8 OR 9 IN
BA11.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(21)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA12E 161 OTHER
_____
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 2, 7, 8 OR 9 IN
BA11.
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BA12EOS - BA13
BA12EOS 162-163 OTHER SPECIFIED
_______________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 2, 7, 8 OR 9 IN
BA11; OR CODED 2, 7, 8 OR 9 IN BA12E.
* 01 = RESEARCH STUDY
* 03 = FLAT FEE
* 05 = GAY AIDS TASK FORCE/AIDS NETWORK
* 14 = FAMILY/FRIEND
* 29 = COMMUNITY HEALTH PROJECT
* 46 = PROVIDER
* 47 = PRIVATE CHARITY/GRANT FROM AIDS FOUNDATION
* 50 = DRUG CO
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BA13
(22)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BA13 164-165 WHY WAS THERE NO (ADDITIONAL) PAYMENT?
_______________________________________
+ = INAPPLICABLE, CODED 01, 02, 03, 04, 06, 07, 08, 10, 11, 12, 13, 91, 97,
98 OR 99 IN BA5 AND CODED 2, 7, 8, OR 9 IN BA6C; OR CODED 1 IN BA11.
01 = FREE FROM PROVIDER
02 = PAID IN FULL
03 = CAN'T AFFORD TO PAY
05 = RESEARCH STUDY
06 = GOVT AGENCY/GOVT FUNDED: LOCAL CITY COUNTY
18 = INCLUDED IN OTHER FEE/FLAT FEE
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BINSCOVR (166-261) INSURANCE COVERAGE
__________________
BBBOX1 (166-172) TIME 1 INSURANCE STATUS. R HAD: (CHECK ALL THAT APPLY)
________________________________________________________
BBBOX1A 166 PRIVATE INSURANCE: CODE BOX B-2 AND BOX B-3
____________________________________________
1 = YES
2 = NO
BBBOX1B 167 MEDICAID: CODE BOX B-5
_______________________
1 = YES
2 = NO
BBBOX1C 168 MEDICARE
________
1 = YES
2 = NO
(23)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBBOX1D 169 OTHER PUBLIC ASSISTANCE: CODE BOX B-6, BOX B-7
_______________________________________________
1 = YES
2 = NO
BBBOX1E 170 ALWAYS BLANK
____________
+ = ALWAYS BLANK
BBBOX1F 171 CLINICAL TRIAL
______________
1 = YES
2 = NO
BBBOX1G 172 NONE
____
1 = YES,NO COVERAGE
2 = NO,SOME COVERAGE
BB1 173 SINCE (REF. DATE), HAVE YOU BEEN COVERED BY ANY PRIVATE HEALTH INSURANCE PLAN, INCLUDING
AN HMO, THAT PAYS FOR ANY PART OF HOSPITAL BILLS, DOCTOR BILLS, OR SURGEON BILLS?
__________________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BBBOX2
BBBOX2 174 TIME 1 = PRIVATE INSURANCE
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
* 1 = YES
** 2 = NO
* SKIP BBBOX3
** SKIP BBBOX3 - BB6
(24)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBBOX3 175 TIME 1 = PRIVATE INSURANCE
__________________________
+ = INAPPLICABLE, CODED 1 IN BB1.
* 1 = YES
** 2 = NO
* SKIP BB2 - BB4L
** SKIP BB2 - BB10
BB2 176 IS THIS THE SAME PRIVATE HEALTH INSURANCE PLAN YOU TOLD ME ABOUT LAST TIME?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3.
1 = YES
* 2 = NO
* 7 = REFUSED
8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB3 - BB4L
BB3 177 HAVE YOU BEEN COVERED THE WHOLE TIME FROM (REF. DATE) UNTIL TODAY, OR ONLY PART OF THE
TIME?
______
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2.
* 1 = THE WHOLE TIME
2 = PART OF THE TIME
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB4A - BB10
BB4 (178-189) SINCE (REF. DATE), IN WHICH MONTHS WERE YOU COVERED BY PRIVATE INSURANCE FOR THE ENTIRE
MONTH? CIRCLE THE CODE FOR ALL MONTHS THAT APPLY.
CODER: AT LEAST ONE MONTH MUST BE CIRCLED. IF NONE ARE CIRCLED, CODE 9 FOR EACH
MONTH.IF AT LEAST ONE IS CIRCLED,CODE CIRCLED MONTH(S) 1 AND CODE OTHER MONTH(S) 2.
(25)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB4A 178 JANUARY
_______
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4B 179 FEBRUARY
________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4C 180 MARCH
_____
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4D 181 APRIL
_____
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(26)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB4E 182 MAY
___
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4F 183 JUNE
____
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4G 184 JULY
____
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4H 185 AUGUST
______
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(27)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB4I 186 SEPTEMBER
_________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4J 187 OCTOBER
_______
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4K 188 NOVEMBER
________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB4L 189 DECEMBER
________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED IN BBBOX3; OR CODED 2, 7 OR 9
IN BB2; OR CODED 1, 7, 8 OR 9 IN BB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GO TO BB12
(28)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB5 (190-193) WHEN DID YOUR (PREVIOUS) HEALTH INSURANCE COVERAGE END?
CODER: IF BB5YR EQUALS 97, 98 OR 99, CODE 99 IN BB5MO.
BB5MO 190-191 MONTH
_____
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED 2 IN BBBOX3; OR CODED 1 OR 8 IN
BB2.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB5YR 192-193 YEAR
____
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED 2 IN BBBOX3; OR CODED 1 OR 8 IN
BB2.
79-91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB6 194 WAS IT BECAUSE OF YOUR HIV INFECTION THAT THIS HAPPENED?
_________________________________________________________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED 2 IN BBBOX3; OR CODED 1 OR 8 IN
BB2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BBBOX4 195 LOOK AT Q. B-1. R ANSWERED:
______________________________
+ = INAPPLICABLE, CODED 2 IN BBBOX2; OR CODED 2 IN BBBOX3; OR CODED 1 OR 8 IN
BB2.
1 = YES
* 2 = NO
* SKIP BB7 - BB10
(29)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB7 196 IS YOUR CURRENT PLAN INDIVIDUAL OR FAMILY COVERAGE?
____________________________________________________
+ = INAPPLICABLE, CODED ONLY IF BBBOX2 = 2; OR BBBOX4 = 1
1 = INDIVIDUAL PLAN
2 = FAMILY PLAN
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB8 197-198 HOW DO YOU GET YOUR HEALTH INSURANCE OR HEALTH PLAN - THROUGH AN EMPLOYER OR FAMILY
BUSINESS, A UNION, OR SOME OTHER GROUP, OR DIRECTLY FROM AN INSURANCE COMPANY?
_______________________________________________________________________________
+ = INAPPLICABLE, CODED ONLY IF BBBOX2 = 2; OR BBBOX4 = 1
01 = EMPLOYER
02 = UNION
03 = INSURANCE COMPANY
04 = SPECIAL INTEREST GROUP
05 = PUBLIC ASSISTANCE
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB9 (199-202) WHEN DID YOUR CURRENT HEALTH INSURANCE BEGIN?
CODER: IF BB9YR EQUALS 97, 98 OR 99, CODE 99 IN BB9MO.
BB9MO 199-200 MONTH
_____
+ = INAPPLICABLE, CODED ONLY IF BBBOX2 = 2; OR BBBOX4 = 1
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(30)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB9YR 201-202 YEAR
____
+ = INAPPLICABLE, CODED ONLY IF BBBOX2 = 2; OR BBBOX4 = 1
74-91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB10 203 IS THIS PLAN A HEALTH MAINTENANCE ORGANIZATION OR HMO?
_______________________________________________________
+ = INAPPLICABLE, CODED ONLY IF BBBOX2 = 2; OR BBBOX4 = 1
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB12 204 AT ANY TIME SINCE (REF. DATE) HAVE YOU BEEN COVERED BY (MEDICAID/STATE NAME FOR
MEDICAID)?
___________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB13 - BB14L
BB13 205 HAVE YOU BEEN COVERED THE WHOLE TIME FROM (REF. DATE) UNTIL TODAY, OR ONLY PART OF THE
TIME?
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12.
* 1 = THE WHOLE TIME
2 = PART OF THE TIME
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB14A - BB14L
(31)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB14 (206-217) SINCE (REF. DATE), IN WHICH MONTHS WERE YOU COVERED BY (MEDICAID/STATE NAME FOR
MEDICAID) FOR THE ENTIRE MONTH? CIRCLE THE CODE FOR ALL MONTHS THAT APPLY.
CODER: AT LEAST ONE MONTH MUST BE CIRCLED. IF NONE ARE CIRCLED CODE 9 FOR EACH MONTH.
IF AT LEAST ONE IS CIRCLED, CODE CIRCLED MONTH(S) 1 AND CODE OTHER MONTH(S) 2.
BB14A 206 JANUARY
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14B 207 FEBRUARY
________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14C 208 MARCH
_____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(32)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB14D 209 APRIL
_____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14E 210 MAY
___
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14F 211 JUNE
____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14G 212 JULY
____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(33)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB14H 213 AUGUST
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14I 214 SEPTEMBER
_________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14J 215 OCTOBER
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB14K 216 NOVEMBER
________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(34)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB14L 217 DECEMBER
________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB12; OR CODED 1, 7, 8 OR 9 IN BB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GO TO BB19
BBBOX5 218 TIME 1 = MEDICAID
_________________
+ = INAPPLICABLE, CODED 1 IN BB12.
1 = YES
* 2 = NO
* SKIP BB16MO - BB16YR
BB16 (219-222) WHEN DID YOUR (MEDICAID/STATE NAME FOR MEDICAID) COVERAGE END?
CODER: IF BB16YR EQUALS 97, 98 OR 99, CODE 99 IN BB16MO.
BB16MO 219-220 MONTH
_____
+ = INAPPLICABLE, CODED 1 IN BB12; OR CODED 2 IN BBBOX5.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB16YR 221-222 YEAR
____
+ = INAPPLICABLE, CODED 1 IN BB12; OR CODED 2 IN BBBOX5.
91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(35)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB17 223 HAVE YOU (RE-)APPLIED FOR MEDICAID?
____________________________________
+ = INAPPLICABLE, CODED 1 IN BB12.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB18
BB18 224 HAVE YOU BEEN TURNED DOWN FOR MEDICAID?
________________________________________
+ = INAPPLICABLE, CODED 1 IN BB12; OR CODED 2, 7, 8 OR 9 IN BB17.
1 = YES
2 = NO/NO DECISION YET
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB19 225 SINCE (REF.DATE) HAVE YOU BEEN COVERED BY MEDICARE? MEDICARE IS A SOCIAL SECURITY HEALTH
INSURANCE PROGRAM FOR DISABLED PERSONS AND FOR PERSONS 65 YEARS OLD AND OLDER.
_______________________________________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB21 226 SINCE (REF. DATE), HAVE YOU BEEN COVERED BY ANY OTHER PUBLIC ASSISTANCE PROGRAM (BESIDES
MEDICAID/STATE NAME FOR MEDICAID OR MEDICARE) THAT PAYS FOR MEDICAL CARE?
__________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BBBOX6
(36)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBBOX6 227 TIME 1 = OTHER PUBLIC ASSISTANCE
________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB21.
* 1 = YES
** 2 = NO
* SKIP BBBOX7
** SKIP BBBOX7 - BBBOX8
BBBOX7 228 TIME 1 = OTHER PUBLIC ASSISTANCE
________________________________
+ = INAPPLICABLE, CODED 1 IN BB21.
* 1 = YES
** 2 = NO
* SKIP BB22 - BB24L
** SKIP BB22 - BB27YR
BB22 229 IS THIS THE SAME PUBLIC ASSISTANCE PROGRAM YOU TOLD ME ABOUT LAST TIME?
________________________________________________________________________
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB23 - BB24L
BB23 230 HAVE YOU BEEN COVERED THE WHOLE TIME FROM (REF.DATE) UNTIL TODAY, OR ONLY PART OF THE
TIME?
______
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22.
* 1 = THE WHOLE TIME
2 = PART OF THE TIME
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB24A - BB27YR
(37)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB24 (231-242) SINCE (REF.DATE), IN WHICH MONTHS WERE YOU COVERED BY (OTHER PUBLIC ASSISTANCE PROGRAM)
FOR THE ENTIRE MONTH? CIRCLE THE CODE FOR ALL MONTHS THAT APPLY.
CODER: AT LEAST ONE MONTH MUST BE CIRCLED. IF NONE ARE CIRCLED CODE 9 FOR EACH MONTH.
IF AT LEAST ONE IS CIRCLED,CODE CIRCLED MONTH(S) 1 AND CODE OTHER MONTH(S) 2.
BB24A 231 JANUARY
_______
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24B 232 FEBRUARY
________
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24C 233 MARCH
_____
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(38)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB24D 234 APRIL
_____
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24E 235 MAY
___
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24F 236 JUNE
____
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24G 237 JULY
____
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(39)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB24H 238 AUGUST
______
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24I 239 SEPTEMBER
_________
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24J 240 OCTOBER
_______
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB24K 241 NOVEMBER
________
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(40)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB24L 242 DECEMBER
________
+ = INAPPLICABLE, CODED 2 IN BBBOX6; OR CODED IN BBBOX7; OR CODED 2, 7, 8 OR
9 IN BB22; OR CODED 1, 7, 8 OR 9 IN BB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GO TO BB28
BB25 (243-246) (LAST TIME YOU TOLD ME YOU WERE COVERED BY SOME PUBLIC ASSISTANCE PROGRAM.) WHEN DID YOUR
COVERAGE UNDER THAT PROGRAM END?
CODER: IF BB25YR EQUALS 97, 98 OR 99, CODE 99 IN BB25MO.
BB25MO 243-244 MONTH
_____
+ = INAPPLICABLE, CODED ONLY IF BBBOX7 = 1; OR BB22 = 2, 7, 8 OR 9.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB25YR 245-246 YEAR
____
+ = INAPPLICABLE, CODED ONLY IF BBBOX7 = 1; OR BB22 = 2, 7, 8 OR 9.
91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(41)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBBOX8 247 LOOK AT Q B-21. R ANSWERED:
_____________________________
+ = INAPPLICABLE, CODED ONLY IF BBBOX7 = 1; OR BB22 = 2, 7, 8 OR 9.
1 = YES
* 2 = NO
* SKIP BB26 - BB27YR
BB26 248-249 WHAT IS THE NAME OF THIS CURRENT PROGRAM?
__________________________________________
+ = INAPPLICABLE, CODED ONLY OF BBBOX6 = 2; OR BBBOX8 = 1
70 = DRUG ASSISTANCE PROGRAM
71 = ASSISTANCE FROM PROVIDER - FUNDING UNKNOWN
72 = CITY FUNDED PROGRAM
73 = COUNTY FUNDED PROGRAM
74 = STATE FUNDED PROGRAM
75 = FEDERALLY FUNDED PROGRAM
76 = GOVT FUNDED PROGRAM, NOS
77 = COMMUNITY PROGRAM, FUNDING UNKNOWN
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB27 (250-253) WHEN DID YOUR COVERAGE UNDER THIS CURRENT PROGRAM BEGIN?
CODER: IF BB27YR EQUALS 97, 98 OR 99, CODE 99 IN BB27MO.
BB27MO 250-251 MONTH
_____
+ = INAPPLICABLE, CODED ONLY OF BBBOX6 = 2; OR BBBOX8 = 1
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(42)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB27YR 252-253 YEAR
____
+ = INAPPLICABLE, CODED ONLY OF BBBOX6 = 2; OR BBBOX8 = 1
82-91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BB28 254 ARE YOU NOW COVERED BY CHAMPUS (WHICH COVERS BOTH ACTIVE DUTY AND RETIRED CAREER MILITARY
PERSONNEL, THEIR DEPENDENTS AND SURVIVORS) OR CHAMPVA (WHICH COVERS DISABLED VETERANS,
THEIR DEPENDENTS AND SURVIVORS)?
_________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB29 255 ARE YOU CURRENTLY PARTICIPATING IN ANY CLINICAL TRIALS FOR ANY MEDICATIONS?
____________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB31A1 - BB31B2
BB31 (256-261) HOW LONG HAVE YOU BEEN PARTICIPATING IN THIS/THESE TRIALS?
___________________________________________________________
BB31A (256-258) LENGTH OF TIME IN FIRST TRIAL
_____________________________
(43)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB31A1 256-257 LENGTH OF FIRST TRIAL
_____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB29.
01-90 = AMOUNT
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BB31A2
BB31A2 258 UNIT OF FIRST TRIAL
___________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB29; OR CODED 97, 98 OR 99 IN
BB31A1.
1 = DAYS
2 = WEEKS
3 = MONTHS
4 = YEARS
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB31B (259-261) LENGTH OF TIME IN SECOND TRIAL
______________________________
BB31B1 259-260 LENGTH OF SECOND TRIAL
______________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB29.
01-90 = AMOUNT
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BB31B2
(44)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB31B2 261 UNIT OF SECOND TRIAL
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB29; OR CODED 97, 98 OR 99 IN
BB31B1; OR ONLY ONE LISTED.
1 = DAYS
2 = WEEKS
3 = MONTHS
4 = YEARS
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BIPSTAYS (262-266) INPATIENT HOSPITAL STAYS
________________________
BD1A 262 SINCE (REF. DATE), HAVE YOU BEEN A PATIENT IN A HOSPITAL OVERNIGHT OR LONGER?
_______________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BD1B
BD1B 263-264 HOW MANY TIMES HAVE YOU BEEN IN THE HOSPITAL OVERNIGHT OR LONGER SINCE (REF. DATE)?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BD1A.
01-96 = NUMBER OF TIMES
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BD06CT 265-266 NUMBER OF INPATIENT STAY RECORDS
________________________________
00 = NONE LISTED
01-99 = NUMBER
BNURSHOM (267-271) NURSING HOME/RESIDENTIAL CARE STAYS
___________________________________
(45)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BE1A 267 HAVE YOU BEEN A PATIENT IN A RESIDENTIAL CARE FACILITY, A NURSING HOME OR HOSPICE
OVERNIGHT OR LONGER?
_____________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BE1B
BE1B 268-269 HOW MANY TIMES HAVE YOU BEEN IN A RESIDENTIAL CARE FACILITY, NURSING HOME OR HOSPICE
OVERNIGHT OR LONGER SINCE (REF DATE)?
______________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BE1A.
01-96 = NUMBER OF TIMES
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BE08CT 270-271 NUMBER OF NURSING HOME/RESIDENTIAL CARE RECORDS
_______________________________________________
00 = NONE LISTED
01-99 = NUMBER
BMEDVIST (272-291) MEDICAL VISITS
______________
BF1 272 SINCE (REF. DATE ) DID YOU GO TO A HOSPITAL EMERGENCY ROOM FOR MEDICAL CARE? INCLUDE
ANY VISITS TO THE EMERGENCY ROOM, (EVEN IF YOU WERE ADMITTED TO THE HOSPITAL FROM THERE).
__________________________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BF1A
(46)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BF1A 273-274 HOW MANY DIFFERENT EMERGENCY ROOMS DID YOU VISIT SINCE (REF. DATE)?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BF1.
01-96 = NUMBER OF EMERGENCY ROOMS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BF1ACT 275-276 NUMBER OF EMERGENCY ROOM RECORDS
________________________________
00 = NONE LISTED
01-99 = NUMBER
BF2 277 SINCE (REF. DATE ), DID YOU GO TO A HOSPITAL CLINIC OR HOSPITAL OUT-PATIENT DEPARTMENT
FOR MEDICAL CARE? THESE VISITS COULD INCLUDE AN AEROSOL PENTAMIDINE CLINIC, AN EYE
CLINIC, A LABORATORY WHERE THEY MIGHT CONDUCT BLOOD TESTS, OR A THERAPIST WHO WORKS IN A
HOSPITAL.
__________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BF2A
BF2A 278-279 HOW MANY DIFFERENT HOSPITAL CLINICS AND-OR HOSPITAL OUT-PATIENT DEPARTMENTS DID YOU VISIT
SINCE (REF. DATE)?
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BF2.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BF2ACT 280-281 NUMBER OF HOSPITAL CLINIC RECORDS
_________________________________
00 = NONE LISTED
01-99 = NUMBER
(47)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BF3 282 SINCE (REF. DATE), HAVE YOU BEEN TO ANY OTHER MEDICAL CLINIC, FOR EXAMPLE, A COMMUNITY
CLINIC OR A NEIGHBORHOOD HEALTH CENTER? THESE VISITS COULD INCLUDE BLOOD TESTS, OR OTHER
LAB WORK, OR SCANS LIKE MRI'S OR X-RAY PROCEDURES.
___________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BF3A
BF3A 283-284 HOW MANY DIFFERENT MEDICAL CLINICS DID YOU VISIT SINCE (REF. DATE)?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BF3.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BF3ACT 285-286 NUMBER OF MEDICAL CLINIC RECORDS
________________________________
00 = NONE LISTED
01-99 = NUMBER
BF4 287 SINCE (REF. DATE), HAVE YOU BEEN TO A PRIVATE DOCTOR'S OFFICE FOR MEDICAL CARE? THESE
VISITS COULD ALSO INCLUDE BLOOD TESTS, OTHER LAB WORK, OR SCANS LIKE MRI'S OR X-RAY
PROCEDURES.
____________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BF4A
BF4A 288-289 HOW MANY DIFFERENT PRIVATE DOCTOR'S OFFICES DID YOU VISIT SINCE (REF. DATE)?
______________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BF4.
01-05 = NUMBER OF PROVIDERS
(48)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BF4ACT 290-291 NUMBER OF PRIVATE DOCTOR'S OFFICE RECORDS
_________________________________________
00 = NONE LISTED
01-99 = NUMBER
BOTHPROV (292-311) OTHER HEALTH CARE PROVIDERS
___________________________
BG1 292 SINCE (REF. DATE), HAVE YOU ATTENDED A SUPPORT GROUP, OR RECEIVED ANY PSYCHOLOGICAL
COUNSELING OR THERAPY? PLEASE DO NOT INCLUDE TREATMENT RECEIVED FOR PROBLEMS RELATED TO
DRUG OR ALCOHOL USE.
_____________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BG1A
BG1A 293-294 HOW MANY DIFFERENT SUPPORT GROUPS OR PSYCHOLOGICAL COUNSELORS DID YOU VISIT SINCE (REF.
DATE)?
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BG1.
01-04 = NUMBER OF PROVIDERS
BG1ACT 295-296 NUMBER OF MENTAL HEALTH PROVIDER RECORDS
________________________________________
00 = NONE LISTED
01-99 = NUMBER
(49)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BG2 297 SINCE (REF. DATE), HAVE YOU RECEIVED CARE FROM ANY MEDICAL PRACTITIONERS SUCH AS
OPTOMETRISTS, FOOT DOCTORS, OR CHIROPRACTORS?
______________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BG2A
BG2A 298-299 YOU TOLD ME YOU USED THE SERVICES OF A (PROVIDER). HOW MANY DIFFERENT (PROVIDERS) DID
YOU VISIT SINCE (REF. DATE)?
______________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BG2.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BG2ACT 300-301 NUMBER OF MEDICAL PRACTITIONER RECORDS
______________________________________
00 = NONE LISTED
01-99 = NUMBER
BG3 302 SINCE (REF. DATE), HAVE YOU RECEIVED TREATMENT FROM ANY ALTERNATIVE THERAPIST, A
PRACTITIONER OF HOLISTIC MEDICINE, A NUTRITIONIST, OR ANY OTHER ALTERNATIVE THERAPY LIKE
BIOFEEDBACK?
_____________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BG3A
BG3A 303-304 YOU TOLD ME YOU USED THE SERVICES OF A (PROVIDER). HOW MANY DIFFERENT (PROVIDERS) DID
YOU VISIT SINCE (REF. DATE)?
______________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BG3.
01-04 = NUMBER OF PROVIDERS
(50)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BG3ACT 305-306 NUMBER OF ALTERNATIVE THERAPIST RECORDS
_______________________________________
00 = NONE LISTED
01-99 = NUMBER
BG4 307 SINCE (REF. DATE), DID YOU BUY OR REPLACE ANY SPECIAL MEDICAL EQUIPMENT LIKE EYEGLASSES,
A CANE OR A NEBULIZER?
_______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BG4ACT 308-309 NUMBER OF MEDICAL EQUIPMENT PROVIDER RECORDS
____________________________________________
00 = NONE LISTED
01-99 = NUMBER
BHOMHLTH (310-313) HOME HEALTH CARE
________________
BH1 310 SOMETIMES WHEN PEOPLE ARE ILL, THEY NEED TO RECEIVE HELP AT HOME. THIS HELP COULD BE FOR
MEDICAL PROBLEMS, FOR HELP WITH PERSONAL CARE OR HOUSEKEEPING, OR FOR OTHER SERVICES THEY
MIGHT NEED. PLEASE LOOK AT THIS CARD. IT SHOWS SOME OF THE DIFFERENT KINDS OF HELP
PEOPLE CAN RECEIVE AT HOME. SINCE (REF. DATE), HAVE YOU RECEIVED ANY HELP OF THIS KIND
AT HOME. (CIRCLE THE PROVIDER TYPE IN COLUMN A.)
_________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(51)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BH2 311 SINCE (REF. DATE), HAVE YOU RECEIVED HELP AT HOME BY ANY OTHER PEOPLE NOT SHOWN ON THE
CARD? (SPECIFY THE PROVIDER TYPE IN COLUMN A.)
_______________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BHACT 312-313 NUMBER OF HOME HEALTH CARE PROVIDER RECORDS
___________________________________________
00 = NONE LISTED
01-10 = NUMBER
B_NONMED (314-337) NON - MEDICAL SERVICES
______________________
BI1 314 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH FINDING
OR KEEPING A PLACE TO LIVE?
____________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI1CT 315-316 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH HOUSING
____________________________________________________
00 = NONE
01-99 = NUMBER
(52)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BI2 317 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH LEGAL
SERVICES?
__________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI2CT 318-319 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH LEGAL SERVICES
___________________________________________________________
00 = NONE
01-99 = NUMBER
BI3 320 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH CHILD
CARE?
______
1 = YES
2 = NO
3 = NO CHILDREN
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI3CT 321-322 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH CHILD CARE
_______________________________________________________
00 = NONE
01-99 = NUMBER
BI4 323 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH
TRANSPORTATION?
________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(53)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BI4CT 324-325 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH TRANSPORTATION
___________________________________________________________
00 = NONE
01-99 = NUMBER
BI5 326 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH
OBTAINING FOOD?
________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI5CT 327-328 NUMBER OF RECORDS FOR PROVIDERS HELPING OBTAIN FOOD
___________________________________________________
00 = NONE
01-99 = NUMBER
BI6 329 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH
FINANCIAL ASSISTANCE?
______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI6CT 330-331 NUMBER OF RECORDS FOR PROVIDERS HELPING OBTAIN CLOTHING OR HOUSEHOLD ITEMS
__________________________________________________________________________
00 = NONE
01-99 = NUMBER
(54)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BI7 332 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH
OBTAINING NEEDED CLOTHING OR HOUSEHOLD ITEMS?
______________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI7CT 333-334 NUMBER OF RECORDS FOR PROVIDERS HELPING OBTAIN CLOTHING OR HOUSEHOLD ITEMS
__________________________________________________________________________
00 = NONE
01-99 = NUMBER
BI8 335 PEOPLE WITH HIV INFECTION OFTEN NEED HELP WITH OTHER TYPES OF SERVICES AS WELL. SINCE
(REF. DATE), HAVE YOU RECEIVED HELP FROM ANY AGENCY, GROUP OR ORGANIZATION WITH KICKING
A DRUG OR ALCOHOL HABIT?
_________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BI8CT 336-337 NUMBER OF RECORDS FOR ALCOHOL/DRUG TREATMENT PROVIDERS
______________________________________________________
00 = NONE
01-99 = NUMBER
BDNTLSRV (338-342) DENTAL SERVICES
_______________
(55)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BJ1 338 SINCE (REF. DATE), HAVE YOU SEEN A DENTIST, ORAL SURGEON, OR OTHER PROFESSIONAL DENTAL
CARE PROVIDER?
_______________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BJ1A
BJ1A 339-340 SINCE (REF. DATE), HOW MANY TIMES HAVE YOU SEEN A DENTIST, ORAL SURGEON, OR OTHER
PROFESSIONAL DENTAL CARE PROVIDER?
___________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BJ1.
01-96 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BJ1ACT 341-342 NUMBER OF DENTAL VISIT RECORDS
______________________________
00 = NONE
01-99 = NUMBER
BDRGSECT (343-427) HIV - RELATED MEDICINES
_______________________
BK1 343 SINCE (REF. DATE), HAVE YOU TAKEN ANY OF THE MEDICINES OR DRUGS LISTED ON THIS CARD?
(RECORD NAMES IN COLUMN A.)
___________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(56)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK2 344 SINCE (REF. DATE), HAVE YOU TAKEN ANY OTHER PRESCRIPTION MEDICINES OR DRUGS? (IF YES TO
QUESTION K-1 OR K-2, RECORD NAMES IN COLUMN A. IF NAME UNKNOWN, PROBE FOR CONDITION AND
RECORD IN COLUMN A. IF MEDICINE NAME OR CONDITION UNKNOWN, PROBE FOR DRUG PROVIDER NAME
AND ADDRESS.
_____________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BKACT 345-346 NUMBER OF PRESCRIPTION DRUG RECORDS
___________________________________
00 = NONE LISTED
01-99 = NUMBER
BK3 347 SINCE (REF. DATE), HAVE YOU TAKEN ANY NON-PRESCRIPTION MEDICINES OR DRUGS OR ANY NON
-TRADITIONAL SUBSTANCES TO HELP DEAL WITH HIV/AIDS RELATED ILLNESSES?
______________________________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BK3CT 348-349 NUMBER OF NON-PRESCRIPTION DRUGS/NON-TRADITIONAL SUBSTANCES LISTED IN QUESTION J-4
* 00 = NO DRUGS LISTED
01-99 = NUMBER OF DRUGS LISTED
* SKIP BK4A - BK5
BK4 (350-421) WHAT ARE THE NAMES OF THE NON-PRESCRIPTION DRUGS OR NON-TRADITIONAL SUBSTANCES THAT YOU
ARE TAKING?
____________
(57)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK4A 350-352 NON - PRESCRIPTION DRUG 1
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4B 353-355 NON - PRESCRIPTION DRUG 2
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4C 356-358 NON - PRESCRIPTION DRUG 3
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4D 359-361 NON - PRESCRIPTION DRUG 4
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(58)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK4E 362-364 NON - PRESCRIPTION DRUG 5
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4F 365-367 NON - PRESCRIPTION DRUG 6
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4G 368-370 NON - PRESCRIPTION DRUG 7
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4H 371-373 NON - PRESCRIPTION DRUG 8
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(59)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK4I 374-376 NON - PRESCRIPTION DRUG 9
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4J 377-379 NON - PRESCRIPTION DRUG 10
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4K 380-382 NON - PRESCRIPTION DRUG 11
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4L 383-385 NON - PRESCRIPTION DRUG 12
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(60)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK4M 386-388 NON - PRESCRIPTION DRUG 13
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4N 389-391 NON - PRESCRIPTION DRUG 14
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3: AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
99 = NOT ASCERTAINED
BK4O 392-394 NON - PRESCRIPTION DRUG 15
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4P 395-397 NON - PRESCRIPTION DRUG 16
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(61)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK4Q 398-400 NON - PRESCRIPTION DRUG 17
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4R 401-403 NON - PRESCRIPTION DRUG 18
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4S 404-406 NON - PRESCRIPTION DRUG 19
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4T 407-409 NON - PRESCRIPTION DRUG 20
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(62)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK4U 410-412 NON - PRESCRIPTION DRUG 21
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4V 413-415 NON - PRESCRIPTION DRUG 22
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4W 416-418 NON - PRESCRIPTION DRUG 23
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BK4X 419-421 NON - PRESCRIPTION DRUG 24
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3; AND CODED 00 IN BK3CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(63)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BK5 422-427 WE'RE INTERESTED IN THE TOTAL AMOUNT YOU SPENT ON (MEDICINE). HOW MUCH DID YOU PAY FOR
(MEDICINES IN Q K-4) SINCE (REF. DATE)?
CODER: CODE AMOUNTS IN WHOLE DOLLARS.
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BK3.
000000 = NOTHING
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BFUNCTN (428-483) FUNCTIONAL STATUS
_________________
BL1 428 IN GENERAL, WOULD YOU SAY THAT YOUR HEALTH IS EXCELLENT, VERY GOOD, GOOD, FAIR OR POOR?
________________________________________________________________________________________
1 = EXCELLENT
2 = VERY GOOD
3 = GOOD
4 = FAIR
5 = POOR
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2 (429-444) I AM GOING TO READ YOU SOME PROBLEMS PEOPLE CAN HAVE IN THEIR DAILY LIVES. THINKING
ABOUT YOUR LIFE SINCE (REF. DATE), PLEASE TELL ME WHETHER THESE PROBLEMS HAVE BEEN TRUE
FOR YOU MOST OF THE TIME. (READ ITEMS A-P). HAS THAT BEEN TRUE FOR YOU MOST OF THE
TIME?
______
BL2A 429 I HAVE PAIN AT NIGHT
____________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(64)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL2B 430 I TAKE TABLETS TO HELP ME SLEEP
_______________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2C 431 I HAVE UNBEARABLE PAIN
______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2D 432 I'M TIRED ALL THE TIME
______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2E 433 I FIND IT PAINFUL TO CHANGE POSITION
____________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2F 434 I'M IN PAIN WHEN I WALK
_______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(65)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL2G 435 I'M WAKING UP IN THE EARLY HOURS OF THE MORNING
_______________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2H 436 EVERYTHING IS AN EFFORT
_______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2I 437 I LIE AWAKE FOR MOST OF THE NIGHT
_________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2J 438 I'M IN PAIN WHEN I'M STANDING
_____________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2K 439 IT TAKES ME A LONG TIME TO GET TO SLEEP
_______________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(66)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL2L 440 I SOON RUN OUT OF ENERGY
________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2M 441 I'M IN CONSTANT PAIN
____________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2N 442 I'M IN PAIN WHEN GOING UP AND DOWN STAIRS
_________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2O 443 I SLEEP BADLY AT NIGHT
______________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL2P 444 I'M IN PAIN WHEN I'M SITTING
____________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(67)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL3 (445-450) I'M GOING TO READ YOU A LIST OF ACTIVITIES. PLEASE TELL ME HOW LONG, IF AT ALL, YOUR
HEALTH HAS LIMITED YOU IN EACH ACTIVITY. (READ ITEM) HAS YOUR HEALTH LIMITED YOU FOR
MORE THAN 3 MONTHS, LESS THAN 3 MONTHS OR NOT LIMITED YOU AT ALL.
__________________________________________________________________
BL3A 445 THE KINDS OR AMOUNTS OF VIGOROUS ACTIVITIES YOU CAN DO, LIKE LIFTING HEAVY OBJECTS,
RUNNING OR PARTICIPATING IN STRENUOUS SPORTS
____________________________________________
1 = LIMITED FOR MORE THAN 3 MONTHS
2 = LIMITED FOR 3 MONTHS OR LESS
3 = NOT LIMITED AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL3B 446 THE KINDS OR AMOUNTS OF MODERATE ACTIVITIES YOU CAN DO LIKE A MOVING A TABLE, CARRYING
GROCERIES OR BOWLING
____________________
1 = LIMITED FOR MORE THAN 3 MONTHS
2 = LIMITED FOR 3 MONTHS OR LESS
3 = NOT LIMITED AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL3C 447 WALKING UPHILL OR CLIMBING A FEW FLIGHTS OF STAIRS
__________________________________________________
1 = LIMITED FOR MORE THAN 3 MONTHS
2 = LIMITED FOR 3 MONTHS OR LESS
3 = NOT LIMITED AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL3D 448 BENDING, LIFTING OR STOOPING
____________________________
1 = LIMITED FOR MORE THAN 3 MONTHS
2 = LIMITED FOR 3 MONTHS OR LESS
3 = NOT LIMITED AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(68)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL3E 449 WALKING ONE BLOCK
_________________
1 = LIMITED FOR MORE THAN 3 MONTHS
2 = LIMITED FOR 3 MONTHS OR LESS
3 = NOT LIMITED AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL3F 450 EATING, DRESSING, BATHING OR USING THE TOILET
_____________________________________________
1 = LIMITED FOR MORE THAN 3 MONTHS
2 = LIMITED FOR 3 MONTHS OR LESS
3 = NOT LIMITED AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL4 451 SINCE (REF. DATE), HAS YOUR HEALTH KEPT YOU FROM WORKING AT A JOB, DOING WORK AROUND THE
HOUSE OR GOING TO SCHOOL?
__________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BL5
BL5 452 DID YOUR HEALTH ALSO KEEP YOU FROM DOING THESE KINDS OF ACTIVITIES (REF. DATE)?
_________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BL4.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(69)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL6 453 SINCE (REF. DATE), HAVE YOU BEEN UNABLE TO DO CERTAIN KINDS OR AMOUNTS OF WORK,
HOUSEWORK OR SCHOOLWORK BECAUSE OF YOUR HEALTH?
________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BL7
BL7 454 WERE YOU ALSO UNABLE TO DO THESE KINDS OF ACTIVITIES BECAUSE OF YOUR HEALTH BEFORE (REF.
DATE)?
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BL6.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL8 455 IN THE PAST MONTH, HOW OFTEN HAVE YOU SPENT TIME WITH OR TALKED TO RELATIVES OR FRIENDS -
DAILY, SEVERAL TIMES A WEEK, SEVERAL TIMES A MONTH, ONCE OR TWICE, OR NOT AT ALL?
(CIRCLE ONLY ONE)
_________________
1 = DAILY
2 = SEVERAL TIMES A WEEK
3 = SEVERAL TIMES A MONTH (WEEKLY)
4 = ONCE OR TWICE
5 = NOT AT ALL
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(70)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL9 456 DURING THE PAST MONTH, HOW MUCH OF THE TIME HAS YOUR HEALTH LIMITED YOUR SOCIAL
ACTIVITIES LIKE VISITING WITH FRIENDS OR RELATIVES? PLEASE LOOK AT THIS CARD AND TELL ME
THE ANSWER THAT SHOWS HOW MUCH OF THE TIME YOU HAVE BEEN LIMITED.
__________________________________________________________________
1 = ALL OF THE TIME
2 = MOST OF THE TIME
3 = A GOOD BIT OF THE TIME
4 = SOME OF THE TIME
5 = A LITTLE BIT OF THE TIME
6 = NONE OF THE TIME
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL10 (457-461) PLEASE LOOK AT THIS CARD AGAIN AND TELL ME THE ANSWER THAT COMES CLOSEST TO THE WAY
YOU'VE BEEN FEELING. DURING THE PAST MONTH, HOW MUCH OF THE TIME:
___________________________________________________________________
BL10A 457 HAVE YOU BEEN A VERY NERVOUS PERSON?
_____________________________________
1 = ALL OF THE TIME
2 = MOST OF THE TIME
3 = A GOOD BIT OF THE TIME
4 = SOME OF THE TIME
5 = A LITTLE BIT OF THE TIME
6 = NONE OF THE TIME
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL10B 458 HAVE YOU FELT CALM AND PEACEFUL?
_________________________________
1 = ALL OF THE TIME
2 = MOST OF THE TIME
3 = A GOOD BIT OF THE TIME
4 = SOME OF THE TIME
5 = A LITTLE BIT OF THE TIME
6 = NONE OF THE TIME
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(71)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL10C 459 HAVE YOU FELT DOWNHEARTED AND BLUE?
____________________________________
1 = ALL OF THE TIME
2 = MOST OF THE TIME
3 = A GOOD BIT OF THE TIME
4 = SOME OF THE TIME
5 = A LITTLE BIT OF THE TIME
6 = NONE OF THE TIME
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL10D 460 HAVE YOU BEEN A HAPPY PERSON?
______________________________
1 = ALL OF THE TIME
2 = MOST OF THE TIME
3 = A GOOD BIT OF THE TIME
4 = SOME OF THE TIME
5 = A LITTLE BIT OF THE TIME
6 = NONE OF THE TIME
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL10E 461 HAVE YOU FELT SO DOWN IN THE DUMPS THAT NOTHING COULD CHEER YOU UP?
____________________________________________________________________
1 = ALL OF THE TIME
2 = MOST OF THE TIME
3 = A GOOD BIT OF THE TIME
4 = SOME OF THE TIME
5 = A LITTLE BIT OF THE TIME
6 = NONE OF THE TIME
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(72)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL11 462-463 LOOK AT FLAP. (NOT INCLUDING YOUR SPOUSE/PARTNER), HOW MANY FAMILY MEMBERS OR FRIENDS,
IF ANY, CAN YOU CONFIDE IN AND TALK TO ABOUT PERSONAL FEELINGS AND PROBLEMS?
_____________________________________________________________________________
00 = NONE
01-95 = NUMBER
96 = GREATER THAN 95
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BL12 464 NOW I'D LIKE TO GET SOME INFORMATION ABOUT YOUR FAMILY. IS YOUR MOTHER STILL LIVING?
______________________________________________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL13 465 IS YOUR FATHER STILL LIVING?
_____________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BL14 466-467 HOW MANY BROTHERS DO YOU HAVE?
_______________________________
00 = NONE
01-15 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BL15 468-469 HOW MANY SISTERS DO YOU HAVE?
______________________________
00 = NONE
01-16 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(73)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BLBOX1 470-471 TOTAL LIVING PARENTS AND SIBLING = ASK L -16 AND L-17 UNTIL TOTAL IS ACCOUNTED FOR. ZERO
- FILL REMAINING ANSWER CATEGORIES.
____________________________________
* 00 = NONE
01-95 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
* SKIP BL16A - BL17C
BL16 (472-477) COUNTING ALL THESE FAMILY MEMBERS TOGETHER, HOW MANY LIVE WITHIN:
__________________________________________________________________
BL16A 472-473 30 MINUTES TRAVEL TIME OF YOU?
_______________________________
+ = INAPPLICABLE, CODED 00 IN BLBOX1
00 = NONE
01-20 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BL16B 474-475 1 HOUR TRAVEL TIME OF YOU?
___________________________
+ = INAPPLICABLE, CODED 00 IN BLBOX1
00 = NONE
01-20 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BL16C 476-477 2 HOURS TRAVEL TIME OF YOU?
____________________________
+ = INAPPLICABLE, CODED 00 IN BLBOX1
00 = NONE
01-20 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(74)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BL17 (478-483) COUNTING ALL THESE FAMILY MEMBERS TOGETHER, HOW MANY LIVE IN:
______________________________________________________________
BL17A 478-479 A LARGE CITY (POPULATION GREATER THAN 100,000)?
________________________________________________
+ = INAPPLICABLE, CODED 00 IN BLBOX1
00 = NONE
01-24 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BL17B 480-481 A SUBURBAN AREA OR SMALL CITY (POPULATION AT LEAST 50,000)?
____________________________________________________________
+ = INAPPLICABLE, CODED 00 IN BLBOX1
00 = NONE
01-20 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BL17C 482-483 A RURAL AREA?
______________
+ = INAPPLICABLE, CODED 00 IN BLBOX1
00 = NONE
01-20 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BCAREACS (484) ACCESS AND BARRIERS TO CARE
___________________________
(75)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM1 484 IS THERE A PARTICULAR CLINIC, HEALTH CENTER, DOCTOR'S OFFICE OR OTHER PLACE THAT YOU
USUALLY GO FOR MEDICAL CARE OR ADVICE ABOUT YOUR HEALTH?
_________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM2A - BM8YRS
BM2 (485-493) WHAT KIND OF PLACE IS THAT - A CLINIC, A HOSPITAL, A DOCTOR'S OFFICE OR SOME OTHER PLACE?
CODE ONLY ONE. PLEASE GIVE ME THE NAME OF THAT PLACE.
_______________________________________________________
BM2A 485-486 PROVIDER TYPE
_____________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1.
01 = CLINIC
02 = HOSPITAL
03 = DOCTOR'S OFFICE
91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BM2PROV
BM2PROV 487-493 PROVIDER ID
___________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1; OR CODED 97, 98 OR 99 IN BM2A.
0000001-
9999996 = RANDOMLY ASSIGNED SEQUENTIAL NUMBER
9999997 = REFUSED
9999998 = DK
9999999 = NOT ASCERTAINED
(76)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM3 494 IS THERE A PARTICULAR DOCTOR THAT YOU USUALLY SEE AT (PLACE IN M-2)
___________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM4 495 DOES (PLACE IN M-2) HAVE SOMEONE WHO HELPS YOU FILL OUT FORMS FOR MEDICARE, HEALTH
INSURANCE OR PUBLIC ASSISTANCE PROGRAMS SUCH AS (MEDICAID OR STATE NAME FOR MEDICAID)?
_______________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM5 496-497 HOW DO YOU USUALLY GET THERE - BY WALKING, DRIVING, BEING DRIVEN BY SOMEONE ELSE, BY
TAXI, OTHER PUBLIC TRANSPORTATION OR SOME OTHER WAY. CODE ONLY ONE.
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1.
01 = WALKING
02 = DRIVING
03 = BEING DRIVEN
04 = TAXI
05 = OTHER PUBLIC TRANSPORTATION
06 = AMBULETE/AMBULENCE/OTHER MEDICAL TRANSPORT
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BM6 (498-502) ABOUT HOW LONG DOES IT USUALLY TAKE TO GET THERE?
__________________________________________________
(77)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM6MIN 498-500 MINUTES
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1; OR CODED IN BM6HRS.
* 001-150 = NUMBER
* 997 = REFUSED
* 998 = DK
* 999 = NOT ASCERTAINED
* SKIP BM6HRS
BM6HRS 501-502 HOURS
_____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1; OR CODED IN BM6MIN.
01-08 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BM7 503 WHEN YOU GO THERE, DO YOU USUALLY HAVE AN APPOINTMENT AHEAD OF TIME, DO YOU JUST WALK IN
OR DO YOU SOMETIMES HAVE AN APPOINTMENT AND SOMETIMES NOT?
___________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1.
1 = HAS APPOINTMENT
2 = JUST WALKS IN
3 = SOMETIMES HAS APPOINTMENT
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM8 (504-507) HOW LONG HAVE YOU BEEN GOING TO (PLACE IN M-2)?
________________________________________________
BM8MOS 504-505 MONTHS
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1; OR CODED IN BM8YRS.
* 01-53 = NUMBER
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BM8YRS
(78)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM8YRS 506-507 YEARS
_____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM1; OR CODED IN BM8MOS.
01-45 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BM9 (508-587) THERE ARE MANY HEALTH CARE SERVICES THAT PEOPLE NEED WHICH THEY SOMETIMES DO NOT RECEIVE.
LOOK AT THIS CARD AND PLEASE TELL ME IF YOU FELT YOU NEEDED ANY OF THESE SERVICES SINCE
(REF. DATE) BUT FOR SOME REASON, YOU DID NOT RECEIVE THEM. CODE ALL THAT APPLY IN
COLUMN A, THEN B-G FOR EACH SERVICE CODED.
___________________________________________
BM9AA 508 YOU FELT THAT YOU NEEDED EMERGENCY CARE, BUT DID NOT RECEIVE IT
_______________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9AB - BM9AG
BM9AB 509 YOU FELT THAT YOU NEEDED EMERGENCY CARE. DO YOU KNOW WHERE YOU CAN GO TO GET EMERGENCY
CARE?
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9AA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(79)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9AC 510 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR EMERGENCY CARE?
___________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9AA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9AD
BM9AD 511 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR EMERGENCY CARE YOURSELF?
_____________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9AA; OR CODED 1 IN BM9AC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9AE 512 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET EMERGENCY CARE?
_______________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9AA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9AF 513 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE EMERGENCY CARE TO YOU?
_________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9AA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9AG
(80)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9AG 514-517 WHY WERE YOU REFUSED EMERGENCY CARE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9AA; OR CODED 2, 7, 8 OR 9 IN BM9AF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9BA 518 YOU FELT THAT YOU NEEDED OVERNIGHT HOSPITAL STAY(S), BUT DID NOT RECEIVE IT
___________________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9BB - BM9BG
BM9BB 519 YOU FELT THAT YOU NEEDED OVERNIGHT STAY. DO YOU KNOW WHERE YOU CAN GO TO GET OVERNIGHT
STAY?
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9BA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(81)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9BC 520 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR OVERNIGHT STAY?
___________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9BA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9BD
BM9BD 521 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR OVERNIGHT STAY YOURSELF?
_____________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9BA; OR CODED 1 IN BM9BC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9BE 522 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET AN OVERNIGHT STAY?
__________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9BA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9BF 523 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE AN OVERNIGHT STAY TO YOU?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9BA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9BG
(82)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9BG 524-527 WHY WERE YOU REFUSED OVERNIGHT STAY? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9BA; OR CODED 2, 7, 8 OR 9 IN BM9BF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9998 = DK
9999 = NOT ASCERTAINED
BM9CA 528 YOU FELT THAT YOU NEEDED ANY HOME SERVICES, BUT DID NOT RECEIVE THEM?
______________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9CB - BM9CG
BM9CB 529 YOU FELT THAT YOU NEEDED HOME SERVICES. DO YOU KNOW WHERE YOU CAN GO TO GET HOME
SERVICES?
__________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9CA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(83)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9CC 530 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR HOME SERVICES?
__________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9CA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9CD
BM9CD 531 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR HOME SERVICES YOURSELF?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9CA; OR CODED 1 IN BM9CC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9CF 532 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE HOME SERVICES TO YOU?
________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9CA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9CG
(84)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9CG 533-536 WHY WERE YOU REFUSED HOME SERVICES? RECORD VERBATIM.
______________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9CA; OR CODED 2, 7, 8 OR 9 IN BM9CF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9DA 537 YOU FELT THAT YOU NEEDED MENTAL HEALTH SERVICES, BUT DID NOT RECEIVE THEM?
___________________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9DB - BM9DG
BM9DB 538 YOU FELT THAT YOU NEEDED MENTAL HEALTH SERVICES. DO YOU KNOW WHERE YOU CAN GO TO GET
MENTAL HEALTH SERVICES?
________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9DA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(85)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9DC 539 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR MENTAL HEALTH
SERVICES?
__________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9DA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9DD
BM9DD 540 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR MENTAL HEALTH SERVICES YOURSELF?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9DA; OR CODED 1 IN BM9DC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9DE 541 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET MENTAL HEALTH SERVICES?
_______________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9DA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9DF 542 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE MENTAL HEALTH SERVICES TO YOU?
_________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9DA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9DG
(86)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9DG 543-546 WHY WERE YOU REFUSED MENTAL HEALTH SERVICES? RECORD VERBATIM.
_______________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9DA; OR CODED 2, 7, 8 OR 9 IN BM9DF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9EA 547 YOU FELT THAT YOU NEEDED RESIDENTIAL CARE, BUT DID NOT RECEIVE IT
_________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9EB - BM9EG
BM9EB 548 YOU FELT THAT YOU NEEDED RESIDENTIAL CARE. DO YOU KNOW WHERE YOU CAN GO TO GET
RESIDENTIAL CARE?
__________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9EA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(87)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9EC 549 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR RESIDENTIAL CARE?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9EA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9ED
BM9ED 550 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR RESIDENTIAL CARE
____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9EA; OR CODED 1 IN BM9EC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9EE 551 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET RESIDENTIAL CARE?
_________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9EA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9EF 552 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE RESIDENTIAL CARE TO YOU?
___________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9EA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9EG
(88)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9EG 553-556 WHY WERE YOU REFUSED RESIDENTIAL CARE? RECORD VERBATIM.
_________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9EA; OR CODED 2, 7, 8 OR 9 IN BM9EF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9FA 557 YOU FELT THAT YOU NEEDED PRESCRIBED MEDICATION, BUT DID NOT RECEIVE IT
______________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9FB - BM9FG
BM9FB 558 YOU FELT THAT YOU NEEDED PRESCRIBED MEDICATION. DO YOU KNOW WHERE YOU CAN GO TO GET
PRESCRIBED MEDICATION?
_______________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9FA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(89)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9FC 559 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR PRESCRIBED MEDICATION?
__________________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9FA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9FD
BM9FD 560 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR PRESCRIBED MEDICATION YOURSELF?
____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9FA; OR CODED 1 IN BM9FC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9FE 561 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET PRESCRIBED MEDICATION?
______________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9FA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9FF 562 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE PRESCRIBED MEDICATION TO YOU?
________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9FA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9FG
(90)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9FG 563-566 WHY WERE YOU REFUSED PRESCRIBED MEDICATION? RECORD VERBATIM.
______________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9FA; OR CODED 2, 7, 8 OR 9 IN BM9FF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9GA 567 YOU FELT THAT YOU NEEDED DENTAL SERVICES, BUT DID NOT RECEIVE THEM?
____________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9GB - BM9GG
BM9GB 568 YOU FELT THAT YOU NEEDED DENTAL SERVICES. DO YOU KNOW WHERE YOU CAN GO TO GET DENTAL
SERVICES?
__________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9GA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(91)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9GC 569 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR DENTAL SERVICES?
____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9GA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9GD
BM9GD 570 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR DENTAL SERVICES YOURSELF?
______________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9GA; OR CODED 1 IN BM9GC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9GE 571 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET DENTAL SERVICES?
________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9GA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9GF 572 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE DENTAL SERVICES TO YOU?
__________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9GA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9GG
(92)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9GG 573-576 WHY WERE YOU REFUSED DENTAL SERVICES? RECORD VERBATIM.
________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9GA; OR CODED 2, 7, 8 OR 9 IN BM9GF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9991 = OTHER SPECIFIED
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9HA 577 YOU FELT THAT YOU NEEDED DRUG TREATMENT SERVICES, BUT DID NOT RECEIVE THEM?
____________________________________________________________________________
1 = CIRCLED
* 2 = NOT CIRCLED
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9HB - BM9HG
BM9HB 578 YOU FELT THAT YOU NEEDED DRUG TREATMENT SERVICES. DO YOU KNOW WHERE YOU CAN GO TO GET
DRUG TREATMENT SERVICES?
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9HA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(93)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9HC 579 (IF YOU KNEW WHERE TO GO) DO YOU HAVE INSURANCE THAT WOULD PAY FOR DRUG TREATMENT
SERVICES?
__________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9HA
* 1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP BM9HD
BM9HD 580 (IF YOU KNEW WHERE TO GO) CAN YOU AFFORD TO PAY FOR DRUG TREATMENT SERVICES YOURSELF?
______________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9HA; OR CODED 1 IN BM9HC
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9HE 581 (IF YOU KNEW WHERE TO GO) WOULD YOU HAVE TRANSPORTATION TO GET DRUG TREATMENT SERVICES?
________________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9HA
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BM9HF 582 SINCE (REF. DATE), HAS ANYONE REFUSED TO PROVIDE DRUG TREATMENT SERVICES TO YOU?
__________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9HA
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BM9HG
(94)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BM9HG 583-586 WHY WERE YOU REFUSED DRUG TREATMENT SERVICES? RECORD VERBATIM.
________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BM9HA; OR CODED 2, 7, 8 OR 9 IN BM9HF
0001 = DISEASE RELATED REASON; EX-HIV POSITIVE/DRUG ADDICT, ETC
0002 = PROVIDER STATED; NO ROOM/NOT ENOUGH AVAILABLE/WAITING LIST
0003 = VARIATIONS OF REASONS PATIENT COULDN'T PAY; INCLUDING WOULD NOT TAKE
MEDICAID, INSURANCE WOULD NOT COVER, ETC
0004 = RESPONDENT WAS TOLD; NOT SICK ENOUGH/DON'T NEED/NOTHING THEY COULD DO FOR
ME
0005 = PATIENT NOT ELIGIBLE FOR SERVICE
0006 = SERVICE NOT AVAILABLE FROM PROVIDER
9991 = OTHER SPECIFIED
9992 = RESPONSE DOES NOT ANSWER THE QUESTION
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BM9IA 587 NO SERVICES WERE NEEDED
_______________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BEMPLYMT (588-684) EMPLOYMENT AND INCOME
_____________________
BN1 588 ARE YOU CURRENTLY WORKING FULL-TIME, PART-TIME, OR ARE YOU CURRENTLY NOT WORKING?
__________________________________________________________________________________
* 1 = FULL - TIME
2 = PART - TIME
** 3 = NOT WORKING
** 7 = REFUSED
** 8 = DK
** 9 = NOT ASCERTAINED
* SKIP BNBOX1 - BNBOX2
** SKIP BNBOX1
(95)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BNBOX1 589 R CURRENTLY WORKING PART-TIME. LOOK AT FACE SHEETS. LAST TIME R WAS:
_______________________________________________________________________
+ = INAPPLICABLE, CODED 1, 3, 7, 8 OR 9 IN BN1
* 1 = WORKING FULL TIME (FT)
** 2 = WORKING PART -TIME (PT)
** 3 = NOT WORKING (NW)
* SKIP BNBOX2 - BN6
** SKIP BNBOX2 - BN15
BNBOX2 590 R CURRENTLY NOT WORKING. LOOK AT FACE SHEETS. LAST TIME R WAS:
_________________________________________________________________
+ = INAPPLICABLE, CODED 1 OR 2 IN BN1
* 1 = WORKING FULL TIME (FT)
* 2 = WORKING PART -TIME (PT)
** 3 = NOT WORKING (NW)
* SKIP BN2 - BN21
** SKIP BN2 - BN27
BN2 591-593 ABOUT HOW MANY HOURS DO YOU CURRENTLY WORK AT THIS JOB IN THE AVERAGE WEEK?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN BN1
001-084 = HOURS PER WEEK
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BN3N4 594-597 WHAT IS YOUR CURRENT OCCUPATION? WHAT ARE YOUR MOST IMPORTANT ACTIVITIES OR DUTIES AT
THIS JOB?
CODER: USE CODES IN CENSUS ALPHABETICAL INDEX OF INDUSTRIES AND OCCUPATIONS, FINAL
EDITION, 1983.
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN BN1
0001-9990 = 1983 CENSUS OCCUPATIONAL CODES
9994 = UNCODEABLE
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
(96)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN4A 598 ABOUT HOW MANY PERSONS ARE EMPLOYED IN A USUAL WEEK AT THE LOCATION WHERE YOU WORK?
WOULD YOU SAY IT WAS:
______________________
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN BN1
1 = LESS THAN 25 PEOPLE
2 = 25 - 99 PEOPLE
3 = 100 - 499 PEOPLE
4 = 500 OR MORE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BN5 599 SINCE (REF. DATE), HAVE YOU HAD TO MAKE ANY CHANGES IN THE TYPE OR AMOUNT OF WORK YOU DO
BECAUSE OF YOUR ILLNESS?
_________________________
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN BN1
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN6 - BN30
BN6 600-601 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN BN1; OR CODED 2, 7, 8 OR 9 IN BN5
* 01 = STOPPED/QUIT WORKING/UNABLE TO WORK DUE TO HEALTH PROBLEMS
* 02 = CAN'T DO WHAT I USED TO DO
* 03 = CHANGED TYPE/AMOUNT OF WORK
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN7 - BN30
(97)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN7 602-604 ABOUT HOW MANY HOURS DO YOU CURRENTLY WORK AT THIS JOB IN THE AVERAGE WEEK?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
001-050 = HOURS PER WEEK
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BN8N9 605-608 WHAT IS YOUR CURRENT OCCUPATION? WHAT ARE YOUR MOST IMPORTANT ACTIVITIES OR DUTIES AT
THIS JOB?
CODER: USE CODES IN CENSUS ALPHABETICAL INDEX OF INDUSTRIES AND OCCUPATIONS, FINAL
EDITION, 1983.
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
0001-9990 = 1983 CENSUS OCCUPATIONAL CODES
9994 = UNCODEABLE
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BN9A 609 ABOUT HOW MANY PERSONS ARE EMPLOYED IN A USUAL WEEK AT THE LOCATION WHERE YOU WORK?
WOULD YOU SAY IT WAS:
______________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
1 = LESS THAN 25 PEOPLE
2 = 25 - 99 PEOPLE
3 = 100 - 499 PEOPLE
4 = 500 OR MORE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(98)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN10 610 ARE YOU ACTIVELY LOOKING FOR (FULL-TIME) WORK?
_______________________________________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BN11 611-612 DID YOU STOP WORKING AT YOUR (LAST) JOB BECAUSE YOU TOOK A LEAVE OF ABSENCE OR DISABILITY
LEAVE, BECAUSE YOU QUIT, WERE LAID OFF, WERE FIRED, WERE TOO ILL OR FOR SOME OTHER
REASON?
________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
01 = LEAVE OF ABSENCE/DISABILITY LEAVE
02 = QUIT
03 = LAID OFF
04 = FIRED
05 = TOO ILL
06 = PREGNANCY
07 = ARRESTED/IN PRISON
08 = RETIRED
09 = KEPT SAME JOB CHANGED TO PT
10 = MOVED/LEFT AREA
11 = JOB ENDED OR BUSINESS CLOSED/MOVED/WAS SOLD
12 = WENT TO SCHOOL
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN12 613 WAS IT BECAUSE OF YOUR HIV INFECTION THAT THIS HAPPENED?
_________________________________________________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(99)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN13 (614-617) IN WHAT MONTH AND YEAR DID YOU LEAVE THAT (FULL TIME) JOB?
CODER: IF BN13YR EQUALS 97, 98, 99, CODE 99 IN BN13MO.
BN13MO 614-615 MONTH THAT LEAVE BEGAN
______________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN13YR 616-617 YEAR THAT LEAVE BEGAN
_____________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN14 618 SINCE (REF. DATE), HAVE YOU HAD TO MAKE ANY CHANGES IN THE TYPE OR AMOUNT OF WORK YOU DO
BECAUSE OF YOUR ILLNESS?
_________________________
+ = INAPPLICABLE, CODED 1 BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2, OR 3
IN BNBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN15 - BN30
(100)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN15 619-620 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 2 OR 3 IN BNBOX1; OR CODED 1, 2 OR
3 IN BNBOX2; OR CODED 2, 7, 8 OR 9 IN BN14.
* 01 = STOPPED/QUIT WORKING/UNABLE TO WORK DUE TO HEALTH PROBLEMS
* 02 = CAN'T DO WHAT I USED TO DO
* 03 = CHANGED TYPE /AMOUNT OF WORK
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN16 - BN30
BN16 621-623 ABOUT HOW MANY HOURS DO YOU CURRENTLY WORK AT THIS JOB IN THE AVERAGE WEEK?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1 IN BNBOX1; OR CODED 1, 2 OR 3 IN
BNBOX2.
001-050 = HOURS PER WEEK
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BN17N18 624-627 WHAT IS YOUR CURRENT OCCUPATION? WHAT ARE YOUR MOST IMPORTANT ACTIVITIES OR DUTIES AT
THIS JOB?
CODER: USE CODES IN CENSUS ALPHABETICAL INDEX OF INDUSTRIES AND OCCUPATIONS, FINAL
EDITION, 1983.
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1 IN BNBOX1; OR CODED 1, 2 OR 3 IN
BNBOX2.
0001-9990 = 1983 CENSUS OCCUPATIONAL CODE
9994 = UNCODEABLE
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
(101)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN18A 628 ABOUT HOW MANY PERSONS ARE EMPLOYED IN A USUAL WEEK AT THE LOCATION WHERE YOU WORK?
WOULD YOU SAY IT WAS:
______________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1 IN BNBOX1; OR CODED 1, 2 OR 3 IN
BNBOX2.
1 = LESS THAN 25 PEOPLE
2 = 25 - 99 PEOPLE
3 = 100 - 499 PEOPLE
4 = 500 OR MORE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BN19 629 ARE YOU ACTIVELY LOOKING FOR FULL TIME WORK?
_____________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1 IN BNBOX1; OR CODED 1, 2 OR 3 IN
BNBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BN20 630 SINCE (REF. DATE), HAVE YOU HAD TO MAKE ANY CHANGES IN THE TYPE OR AMOUNT OF WORK YOU DO
BECAUSE OF YOUR ILLNESS?
_________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1 IN BNBOX1; OR CODED 1, 2 OR 3 IN
BNBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN21 - BN30
(102)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN21 631-632 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1 IN BNBOX1; OR CODED 1, 2 OR 3 IN
BNBOX2; OR CODED 2, 7, 8 OR 9 IN BN20.
* 01 = STOPPED/ QUIT WORKING/ UNABLE TO WORK DUE TO HEALTH PROBLEMS
* 02 = CAN'T DO WHAT I USED TO DO
* 03 = CHANGED TYPE /AMOUNT OF WORK
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN22 - BN30
BN22 633 ARE YOU ACTIVELY LOOKING FOR (FULL-TIME) WORK?
_______________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BN23 634-635 DID YOU STOP WORKING AT YOUR (LAST) JOB BECAUSE YOU TOOK A LEAVE OF ABSENCE OR DISABILITY
LEAVE, BECAUSE YOU QUIT, WERE LAID OFF, WERE FIRED, WERE TOO ILL OR FOR SOME OTHER
REASON?
________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2.
01 = LEAVE OF ABSENCE/DISABILITY LEAVE
02 = QUIT
03 = LAID OFF
04 = FIRED
05 = TOO ILL
06 = PREGNANCY
07 = ARRESTED/IN PRISON
08 = RETIRED
09 = KEPT SAME JOB CHANGED TO PT
10 = MOVED/LEFT
11 = JOB ENDED OR BUSINESS CLOSED/MOVED/WAS SOLD
12 = WENT TO SCHOOL
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(103)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN24 636 WAS IT BECAUSE OF YOUR HIV INFECTION THAT THIS HAPPENED?
_________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BN25 (637-640) IN WHAT MONTH AND YEAR DID YOU LEAVE THAT JOB?
CODER: IF BN25YR EQUALS 97, 98, 99, CODE 99 IN BN25MO.
BN25MO 637-638 MONTH THAT LEAVE BEGAN
______________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN25YR 639-640 YEAR THAT LEAVE BEGAN
_____________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2.
87-91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(104)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN26 641 SINCE (REF. DATE), HAVE YOU HAD TO MAKE ANY CHANGES IN THE TYPE OR AMOUNT OF WORK YOU DO
BECAUSE OF YOUR ILLNESS?
_________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN27 - BN30
BN27 642-643 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2, OR 3 IN BNBOX1; OR CODED 3
IN BNBOX2; OR CODED 2, 7, 8 OR 9 IN BN26.
* 01 = STOPPED/QUIT WORKING/UNABLE TO WORK DUE TO HEALTH PROBLEMS
* 02 = CAN'T DO WHAT I USED TO DO
* 03 = CHANGED TYPE/AMOUNT OF WORK
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN28 - BN30
BN28 644 ARE YOU ACTIVELY LOOKING FOR FULL TIME WORK?
_____________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2 OR 3 IN BNBOX1; OR CODED 1 OR
2 IN BNBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN29 - BN30
(105)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN29 645 SINCE (REF. DATE), HAVE YOU HAD TO MAKE ANY CHANGES IN THE TYPE OR AMOUNT OF WORK YOU DO
BECAUSE OF YOUR ILLNESS?
_________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2 OR 3 IN BNBOX1; OR CODED 1 OR
2 IN BNBOX2; OR CODED 2, 7, 8 OR 9 IN BN28.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN30
BN30 646-647 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN1; OR CODED 1, 2 OR 3 IN BNBOX1; OR CODED 1 OR
2 IN BNBOX2; OR CODED 2, 7, 8 OR 9 IN BN28; OR CODED 2, 7, 8 OR 9 IN
BN29.
01 = STOPPED/QUIT WORKING/UNABLE TO WORK DUE TO HEALTH PROBLEMS
02 = CAN'T DO WHAT I USED TO DO
03 = CHANGED TYPE/AMOUNT OF WORK
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(106)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN31 648-649 WOULD YOU PLEASE LOOK AT THIS CARD AND TELL ME WHICH NUMBER REPRESENTS YOUR TOTAL INCOME
BEFORE TAXES FOR THE PAST MONTH. INCLUDE INCOME FROM ALL SOURCES: YOUR SALARIES, WAGES,
SOCIAL SECURITY, WELFARE AND ANY OTHER INCOME. IF YOU SHARE OR RECEIVE INCOME FROM A
SPOUSE/PARTNER, PLEASE INCLUDE IT IN HERE. CIRCLE ONE CODE.
_____________________________________________________________
01 = $ 0 -200/MO
02 = $ 201 -350/MO
03 = $ 351 -500/MO
04 = $ 501 -750/MO
05 = $ 751 -900/MO
06 = $ 901 -1,150/MO
07 = $ 1,151 -1,300/MO
08 = $ 1,301 -1,450/MO
09 = $ 1,451 -1,600/MO
10 = $ 1,601 -1,750/MO
11 = $ 1,751 -2000/MO
12 = $ 2,001 -3000/MO
13 = $ 3,001 -4,000/MO
14 = $ 4,001 OR MORE/MO
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BNBOX3 650 R WORKING FULL TIME (Q.N-1)
___________________________
* 1 = YES
2 = NO
* SKIP BN32 - BN41YR
BN32 651 SINCE (REF. DATE), HAVE YOU RECEIVED ANY SOCIAL SECURITY DISABILITY PAYMENTS?
_______________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN33MO - BN33BX
BN33 (652-656) IN WHAT MONTH AND YEAR DID YOU RECEIVE YOUR FIRST SOCIAL SECURITY DISABILITY PAYMENT?
______________________________________________________________________________________
(107)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN33DT (652-655) DATE YOU RECEIVED FIRST SOCIAL SECURITY DISABILITY PAYMENT
CODER: IF BN33YR EQUALS 97, 98 OR 99, CODE 99 IN BN33MO
BN33MO 652-653 MONTH YOU RECEIVED FIRST SOCIAL SECURITY DISABILITY PAYMENT
___________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN32 OR CODED
IN BN33BX.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN33YR 654-655 YEAR YOU RECEIVED FIRST SOCIAL SECURITY DISABILITY PAYMENT
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN32 OR CODED
IN BN33BX
* 91 = YEAR
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN33BX
BN33BX 656 FIRST SOCIAL SECURITY DISABILITY PAYMENT BEFORE REFERENCE DATE
______________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN32; OR CODED
IN BN33DT
* 1 = CHECKED
* SKIP BN34 - BN35
(108)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN34 657 HAVE YOU APPLIED FOR SOCIAL SECURITY DISABILITY PAYMENTS?
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BN32; OR CODED 1 IN BNBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN35
BN35 658 HAVE YOU BEEN TURNED DOWN FOR SOCIAL SECURITY DISABILITY?
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 1 IN BN32; OR CODED 2, 7, 8 OR
9 IN BN34
1 = YES
2 = NO/NO DECISION YET
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BNBOX4 659 R HAS: CHILDREN (SEE FLAP)
___________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3.
* 1 = NO CHILDREN LIVING WITH THEM
2 = 1 OR MORE CHILDREN LIVING WITH THEM
* SKIP BN36 - BN37BX
BN36 660 SINCE (REF. DATE), HAVE YOU RECEIVED ASSISTANCE THROUGH THE AID TO FAMILIES WITH
DEPENDENT CHILDREN PROGRAM, SOMETIMES CALLED AFDC OR ADC?
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 1 IN BNBOX4
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN37MO - BN37BX
(109)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN37 (661-665) IN WHAT MONTH AND YEAR DID YOU RECEIVE YOUR FIRST AFDC PAYMENT?
________________________________________________________________
BN37DT (661-664) DATE YOU RECEIVED YOUR FIRST AFDC PAYMENT
CODER: IF BN37YR EQUALS 97, 98, 99, CODE 99 IN BN37MO.
BN37MO 661-662 MONTH YOU RECEIVED YOUR FIRST AFDC PAYMENT.
____________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 1 IN BNBOX4; OR CODED 2, 7, 8
OR 9 IN BN36 OR CODED IN BN37BX
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN37YR 663-664 YEAR YOU RECEIVED YOUR FIRST AFDC PAYMENT
_________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 1 IN BNBOX4; OR CODED 2, 7, 8
OR 9 IN BN36 OR CODED IN BN37BX
* 91 = YEAR
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN37BX
BN37BX 665 FIRST AFDC PAYMENT BEFORE REFERENCE DATE
________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 1 IN BNBOX4; OR CODED 2, 7, 8
OR 9 IN BN36 OR CODED IN BN37DT.
1 = CHECKED
(110)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN38 666 SINCE (REF. DATE), HAVE YOU RECEIVED THE SUPPLEMENTAL SECURITY INCOME OR SSI CHECK?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN39MO - BN39BX
BN39 (667-671) IN WHAT MONTH DID YOU RECEIVE YOUR FIRST SSI PAYMENT?
______________________________________________________
BN39DT (667-670) DATE YOU RECEIVED YOUR FIRST SSI PAYMENT?
CODER: IF BN39YR EQUALS 97, 98 OR 99, CODE 99 IN BN39MO
BN39MO 667-668 MONTH YOU RECEIVED YOUR FIRST SSI PAYMENT
_________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN38; OR CODED
IN BN39BX
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN39YR 669-670 YEAR YOU RECEIVED YOUR FIRST SSI PAYMENT
________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN38; OR CODED
IN BN39BX
* 91 = YEAR
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP BN39BX
(111)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN39BX 671 FIRST SSI PAYMENT BEFORE REFERENCE DATE
_______________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN38; OR CODED
IN BN39DT.
1 = CHECKED
BN40 672 SINCE (REF. DATE), HAVE YOU RECEIVED FOOD STAMPS?
___________________________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN41MO - BN41YR
BN41 (673-676) IN WHAT MONTH DID YOU FIRST RECEIVE FOOD STAMPS?
CODER: IF BN41YR EQUALS 97, 98 OR 99, CODE 99 IN BN41MO
BN41MO 673-674 MONTH YOU FIRST RECEIVED FOOD STAMPS
____________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN40
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
BN41YR 675-676 YEAR YOU FIRST RECEIVED FOOD STAMPS
___________________________________
+ = INAPPLICABLE, CODED 1 IN BNBOX3; OR CODED 2, 7, 8 OR 9 IN BN40
66-91 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(112)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BN42 677 SINCE (REF. DATE), HAVE YOU REGULARLY RECEIVED FINANCIAL SUPPORT, LIKE MONEY TO PAY
BILLS OR FOR FOOD OR RENT, FROM YOUR PARENTS, FRIENDS OR FAMILY MEMBERS?
_________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BN43
BN43 678-683 HOW MUCH HAVE YOU RECEIVED SINCE (REF. DATE)?
CODER: CODE AMOUNTS IN WHOLE DOLLARS
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BN42
000010-010000 = AMOUNT RECEIVED
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BINTOBS (684-695) INTERVIEWER OBSERVATION
_______________________
BP1 684 PLEASE INDICATE YOUR CONFIDENCE IN THE RESPONDENT'S TRUTHFULNESS.
__________________________________________________________________
* 1 = VERY CONFIDENT
* 2 = CONFIDENT
3 = UNSURE
4 = DOUBTFUL
5 = VERY DOUBTFUL
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BP2
(113)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BP2 685-686 WHY?
_____
+ = INAPPLICABLE, CODED 1, 2, 8 OR 9 IN BP1
91 = FLAG FOR QUESTION ANSWERED
98 = DK
99 = NOT ASCERTAINED
BP3 687 PLEASE INDICATE YOUR CONFIDENCE IN THE RESPONDENT'S ACCURACY.
______________________________________________________________
* 1 = VERY CONFIDENT
* 2 = CONFIDENT
3 = UNSURE
4 = DOUBTFUL
5 = VERY DOUBTFUL
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BP4
BP4 688-689 WHY?
_____
+ = INAPPLICABLE, CODED 1, 2, 8 OR 9 IN BP3
91 = FLAG FOR QUESTION ANSWERED
98 = DK
99 = NOT ASCERTAINED
BP5 (690-695) GENERALLY THE RESPONDENT WAS:
______________________________
BP5A 690 ABLE TO UNDERSTAND QUESTIONS
____________________________
1-7 = DEGREE OF UNDERSTANDING
CODER: CODE 1 = ABLE TO UNDERSTAND QUESTIONS EASILY TO CODE 7 = HARDLY ABLE TO
UNDERSTAND THE QUESTION
8 = DK
9 = NOT ASCERTAINED
(114)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BP5B 691 COOPERATIVE
___________
1-7 = DEGREE OF COOPERATION
CODER: CODE 1 = COOPERATIVE TO CODE 7 = UNCOOPERATIVE
8 = DK
9 = NOT ASCERTAINED
BP5C 692 NO LANGUAGE PROBLEM
___________________
1-7 = DEGREE OF LANGUAGE PROBLEM
CODER: CODE 1 = NO LANGUAGE PROBLEM TO CODE 7 = SPOKE ENGLISH WITH DIFFICULTY
8 = DK
9 = NOT ASCERTAINED
BP5D 693 INTERVIEWED WITHOUT INTERRUPTION
________________________________
1-7 = DEGREE OF INTERRUPTIONS DURING INTERVIEW
CODER: CODE 1 = INTERVIEWED WITHOUT INTERRUPTION TO CODE 7 = INTERRUPTED OFTEN
8 = DK
9 = NOT ASCERTAINED
BP5E 694 SOBER
_____
1-7 = LEVEL OF SOBRIETY
CODER: CODE 1 = SOBER TO CODE 7 = INEBRIATED/HIGH
8 = DK
9 = NOT ASCERTAINED
(115)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BP5F 695 PHYSICALLY OR MENTALLY FATIGUED
_______________________________
1-7 = LEVEL OF PHYSICAL/MENTAL FATIGUE
CODER: CODE 1 = NOT PHYSICALLY OR MENTALLY FATIGUED TO CODE 7 = PHYSICALLY OR MENTALLY
FATIGUED
8 = DK
9 = NOT ASCERTAINED
BPIWSEC (696) PATIENT INSURANCE WORKSHEET
___________________________
BB32 696-701 WHAT IS THE PREMIUM OR PAYMENT (OR PART OF THE PREMIUM) THAT YOU PAY FOR YOUR HEALTH
INSURANCE? DO NOT INCLUDE ANY AMOUNT PAID BY YOUR EMPLOYER OR ANY OTHER SOURCE.
_________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
* 000000 = NOTHING
000001-999996 = AMOUNT PAID
* 999997 = REFUSED
* 999998 = DK
* 999999 = NOT ASCERTAINED
* SKIP BB33
BB33 702-703 IS THIS AMOUNT YOU PAY PER WEEK, PER MONTH, PER YEAR OR SOME OTHER PERIOD?
___________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED NONE, 97, 98 OR 99 IN
BB32.
01 = PER WEEK
02 = PER MONTH
03 = QUARTERLY
04 = SEMI - ANNUALLY (EVERY 6 MONTHS)
05 = PER YEAR
06 = TWO TIMES A MONTH/BIWEEKLY
07 = EVERY TWO MONTHS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(116)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB34 704 DO YOU HAVE A DEDUCTIBLE? IS THERE A SPECIFIC DOLLAR AMOUNT THAT YOU PAY OF HEALTH CARE
EXPENSES BEFORE YOUR INSURANCE COMPANY BEGINS TO PAY?
______________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB35A - BB35B
BB35 (705-710) HOW MUCH IS YOUR DEDUCTIBLE?
_____________________________
BB35A 705-709 AMOUNT
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB34.
00001-99996 = AMOUNT
* 99997 = REFUSED
* 99998 = DK
* 99999 = NOT ASCERTAINED
* SKIP BB35B
BB35B 710 IS DEDUCTIBLE DOLLAR AMOUNT OR PERCENTAGE?
___________________________________________
+ = INAPPLICABLE, OR CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN
BB34; OR CODED 97, 98 OR 99 IN BB35A.
1 = AMOUNT IN DOLLARS
2 = PERCENTAGE
BB361 711 DOES YOUR INSURANCE PAY FOR SERVICES WHEN YOU ARE HOSPITALIZED?
________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36A1 - BB36G1
(117)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36A1 712 DO YOU HAVE A CO-PAYMENT, THAT IS, DO YOU HAVE TO PAY SOME OF THE COST OUT OF YOUR OWN
POCKET WHEN YOU ARE HOSPITALIZED?
__________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB36B1 713 IS THERE A PERCENTAGE APPLIED TO THIS BILL, FOR EXAMPLE, YOU WOULD PAY 20% AND THE
INSURANCE COMPANY PAYS 80%, OR DO YOU PAY A FLAT RATE PER INCIDENT?
____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361.
1 = PERCENTAGE
* 2 = FLAT RATE
** 7 = REFUSED
** 8 = DK
** 9 = NOT ASCERTAINED
* SKIP BBR1 - BBINS1
** SKIP BBR1 - BB36D1
BB36C1 (714-719) PERCENTAGES PAID BY RESPONDENT AND INSURANCE COMPANY
____________________________________________________
BBR1 714-716 PERCENTAGE PAID BY RESPONDENT
_____________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361;
OR CODED 2, 7, 8 OR 9 IN BB36B1.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(118)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBINS1 717-719 PERCENTAGE PAID BY INSURANCE COMPANY
____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361;
OR CODED 2, 7, 8 OR 9 IN BB36B1.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BB36D1 720-725 HOW MUCH DO YOU PAY PER (HOSPITALIZATION)?
___________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361;
OR CODED 1, 7, 8 OR 9 IN BB36B1.
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BB361E (726-729) SPECIFIED NUMBER OF FREE (INCIDENTS)
____________________________________
BB36E1 726 IS THERE A SPECIFIED NUMBER OF DAYS THAT ARE FREE (HOSPITALIZATION)?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BBDAYS1
BBDAYS1 727-729 HOW MANY DAYS DOES (HOSPITALIZATION) PAY?
__________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361;
OR CODED 2, 7, 8 OR 9 IN BB36E1.
001-996 = NUMBER OF DAYS
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(119)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36F1 730 DOES THIS CHANGE AFTER YOU HAVE REACHED A SPECIFIED AMOUNT?
____________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36G1
BB36G1 731-734 HOW DOES IT CHANGE
__________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB361;
OR CODED 2, 7, 8 OR 9 IN BB36F1.
0001 = INSURANCE PAYS 100% AFTER SPECIFIED AMOUNT
0002 = LIFETIME LIMIT SPECIFIED
0003 = INSURANCE PAYS 100% UP TO LIFETIME MAXIMUM/YEARLY MAXIMUM
0004 = SPECIFIED TIME LIMIT OR NUMBER OF TIMES/THEN PATIENT MUST PAY
0005 = LIMIT GIVEN BUT NOT SPECIFIED IF YEARLY/LIFETIME
0006 = INSURANCE PAYS 80% UP TO LIMIT
0007 = INSURANCE PAYS UP TO USUAL AND CUSTOMARY PATIENT PAYS REST
0008 = YEARLY MAXIMUM SPECIFIED
0009 = INSURANCE PAYS 100% UP TO LIMIT
0010 = 90% OF USUAL AND CUSTOMARY
0011 = PREAPPROVED - 100%
0012 = INSURANCE PAYS 100% TO LIMIT THEN 80%
9991 = OTHER SPECIFIED
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BB362 735 DOES YOUR INSURANCE PAY FOR SERVICES WHEN YOU MAKE A DOCTOR'S VISIT?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36A2 - BB36G2
(120)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36A2 736 DO YOU HAVE A CO-PAYMENT, THAT IS, DO YOU HAVE TO PAY SOME OF THE COST OUT OF YOUR OWN
POCKET WHEN YOU MAKE A DOCTOR VISIT?
_____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB36B2 737 IS THERE A PERCENTAGE APPLIED TO THIS BILL, FOR EXAMPLE, YOU WOULD PAY 20% AND THE
INSURANCE COMPANY PAYS 80%, OR DO YOU PAY A FLAT RATE PER INCIDENT?
____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362.
1 = PERCENTAGE
* 2 = FLAT RATE
** 7 = REFUSED
** 8 = DK
** 9 = NOT ASCERTAINED
* SKIP BBR2 - BBINS2
** SKIP BBR2 - BB36D2
BB36C2 (738-743) PERCENTAGES PAID BY RESPONDENT AND INSURANCE COMPANY
____________________________________________________
BBR2 738-740 PERCENTAGE PAID BY RESPONDENT
_____________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362;
OR CODED 2, 7, 8 OR 9 IN BB36B2.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(121)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBINS2 741-743 PERCENTAGE PAID BY INSURANCE COMPANY
____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362;
OR CODED 2, 7, 8 OR 9 IN BB36B2.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BB36D2 744-749 HOW MUCH DO YOU PAY PER DOCTOR VISIT?
______________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362;
OR CODED 1, 7, 8 OR 9 IN BB36B2.
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BB36F2 750 DOES THIS CHANGE AFTER YOU HAVE REACHED A SPECIFIED AMOUNT?
____________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36G2
(122)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36G2 751-754 HOW DOES IT CHANGE?
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB362.
OR CODED 2, 7, 8 OR 9 IN BB36F2.
0001 = INSURANCE PAYS 100% AFTER SPECIFIED AMOUNT
0002 = LIFETIME LIMIT SPECIFIED
0003 = INSURANCE PAYS 100% UP TO LIFETIME MAXIMUM/YEARLY MAXIMUM
0004 = SPECIFIED TIME LIMIT OR NUMBER OF TIMES/THEN PATIENT MUST PAY
0005 = LIMIT GIVEN BUT NOT SPECIFIED IF YEARLY/LIFETIME
0006 = INSURANCE PAYS 80% UP TO LIMIT
0007 = INSURANCE PAYS UP TO USUAL AND CUSTOMARY PATIENT PAYS REST
0008 = YEARLY MAXIMUM SPECIFIED
0009 = INSURANCE PAYS 100% UP TO LIMIT
0010 = 90% OF USUAL AND CUSTOMARY
0011 = PREAPPROVED - 100%
0012 = INSURANCE PAYS 100% TO LIMIT THEN 80%
9991 = OTHER SPECIFIED
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
BB363 755 DOES YOUR INSURANCE PAY FOR PRESCRIPTIONS?
___________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36A3 - BB36G3
BB36A3 756 DO YOU HAVE A CO-PAYMENT, THAT IS, DO YOU HAVE TO PAY SOME OF THE COST OUT OF YOUR OWN
POCKET WHEN YOU FILL PRESCRIPTIONS?
____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(123)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36B3 757 IS THERE A PERCENTAGE APPLIED TO THIS BILL, FOR EXAMPLE, YOU WOULD PAY 20% AND THE
INSURANCE COMPANY PAYS 80%, OR DO YOU PAY A FLAT RATE PER PRESCRIPTION?
________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363
1 = PERCENTAGE
* 2 = FLAT RATE
** 7 = REFUSED
** 8 = DK
** 9 = NOT ASCERTAINED
* SKIP BBR3 - BBINS3
** SKIP BBR3 - BB36D3
BB36C3 (758-763) PERCENTAGES PAID BY RESPONDENT AND INSURANCE COMPANY
____________________________________________________
BBR3 758-760 PERCENTAGE PAID BY RESPONDENT
_____________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363
OR CODED 2, 7, 8 OR 9 IN BB36B3.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BBINS3 761-763 PERCENTAGE PAID BY INSURANCE COMPANY
____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363
OR CODED 2, 7, 8 OR 9 IN BB36B3.
000-100 = PERCENTAGE
997 = DK
998 = REFUSED
999 = NOT ASCERTAINED
(124)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36D3 764-769 HOW MUCH DO YOU PAY PER PRESCRIPTION?
______________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363
OR CODED 1, 7, 8 OR 9 IN BB36B3.
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BB36F3 770 DOES THIS CHANGE AFTER YOU HAVE REACHED A SPECIFIED AMOUNT?
____________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36G3
BB36G3 771-774 HOW DOES IT CHANGE?
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB363
OR CODED 2, 7, 8 OR 9 IN BB36F3.
0001 = INSURANCE PAYS 100% AFTER SPECIFIED AMOUNT
0002 = LIFETIME LIMIT SPECIFIED
0003 = INSURANCE PAYS 100% UP TO LIFETIME MAXIMUM/YEARLY MAXIMUM
0004 = SPECIFIED TIME LIMIT OR NUMBER OF TIMES/THEN PATIENT MUST PAY
0005 = LIMIT GIVEN BUT NOT SPECIFIED IF YEARLY/LIFETIME
0006 = INSURANCE PAYS 80% UP TO LIMIT
0007 = INSURANCE PAYS UP TO USUAL AND CUSTOMARY PATIENT PAYS REST
0008 = YEARLY MAXIMUM SPECIFIED
0009 = INSURANCE PAYS 100% UP TO LIMIT
0010 = 90% OF USUAL AND CUSTOMARY
0011 = PREAPPROVED - 100%
0012 = INSURANCE PAYS 100% TO LIMIT THEN 80%
9991 = OTHER SPECIFIED
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
(125)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB364 775 DOES YOUR INSURANCE PAY FOR MENTAL HEALTH SERVICES?
____________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36A4 - BB36MAX
BB36A4 776 DO YOU HAVE A CO-PAYMENT, THAT IS, DO YOU HAVE TO PAY SOME OF THE COST OUT OF YOUR OWN
POCKET WHEN YOU RECEIVE MENTAL HEALTH SERVICES?
________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB36B4 777 IS THERE A PERCENTAGE APPLIED TO THIS BILL, FOR EXAMPLE, YOU WOULD PAY 20% AND THE
INSURANCE COMPANY PAYS 80%, OR DO YOU PAY A FLAT RATE PER INCIDENT?
____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
1 = PERCENTAGE
* 2 = FLAT RATE
** 7 = REFUSED
** 8 = DK
** 9 = NOT ASCERTAINED
* SKIP BBR4 - BBINS4
** SKIP BBR4 - BB36D4
BB36C4 (778-783) PERCENTAGES PAID BY RESPONDENT AND INSURANCE COMPANY
____________________________________________________
(126)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BBR4 778-780 PERCENTAGE PAID BY RESPONDENT
_____________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
OR CODED 2, 7, 8 OR 9 IN BB36B4.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BBINS4 781-783 PERCENTAGE PAID BY INSURANCE COMPANY
____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
OR CODED 2, 7, 8 OR 9 IN BB36B4.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BB36D4 784-789 HOW MUCH DO YOU PAY PER MENTAL HEALTH SERVICE?
_______________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
OR CODED 1, 7, 8 OR 9 IN BB36B4.
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BB36E4 790 IS THERE A LIFETIME MAXIMUM OR A YEARLY MAXIMUM THAT THE INSURANCE COMPANY WILL PAY?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36DOL - BB36MAX
BB36AMT4 (791-797) HOW MUCH WAS PAID FOR MENTAL HEALTH SERVICES?
______________________________________________
(127)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36DOL 791-796 AMOUNT
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364
OR CODED 2, 7, 8 OR 9 IN BB36E4.
000001-999990 = AMOUNT
* 999991 = OTHER SPECIFIED
999996 = EQUAL TO 999996 OR GREATER
* 999997 = REFUSED
* 999998 = DK
* 999999 = NOT ASCERTAINED
* SKIP BB36MAX
BB36MAX 797 TYPE OF MAXIMUM PAID
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB364;
OR CODED 2, 7, 8 OR 9 IN BB36E4; OR CODED 91, 97, 98 OR 99 IN BB36DOL.
1 = LIFETIME MAXIMUM
2 = YEARLY MAXIMUM
3 = RESPONSE GIVEN IN VISITS - NOT IN DOLLARS
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
BB365 798 DOES YOUR INSURANCE PAY FOR A DENTAL CARE PROVIDER?
____________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36A5 - BB36G5
BB36A5 799 DO YOU HAVE A CO-PAYMENT, THAT IS, DO YOU HAVE TO PAY SOME OF THE COST OUT OF YOUR OWN
POCKET FOR DENTAL CARE?
________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(128)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36B5 800 IS THERE A PERCENTAGE APPLIED TO THIS BILL, FOR EXAMPLE, YOU WOULD PAY 20% AND THE
INSURANCE COMPANY PAYS 80%, OR DO YOU PAY A FLAT RATE PER INCIDENT?
____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
1 = PERCENTAGE
* 2 = FLAT RATE
** 7 = REFUSED
** 8 = DK
** 9 = NOT ASCERTAINED
* SKIP BBR5 - BBINS5
** SKIP BBR5 - BB36D5
BB36C5 (801-806) PERCENTAGES PAID BY RESPONDENT AND INSURANCE COMPANY
____________________________________________________
BBR5 801-803 PERCENTAGE PAID BY RESPONDENT
_____________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
OR CODED 2, 7, 8 OR 9 IN BB36B5.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
BBINS5 804-806 PERCENTAGE PAID BY INSURANCE COMPANY
____________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
OR CODED 2, 7, 8 OR 9 IN BB36B5.
000-100 = PERCENTAGE
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(129)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
BB36D5 807-812 HOW MUCH DO YOU PAY PER DENTAL VISIT?
______________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
OR CODED 1, 7, 8 OR 9 IN BB36B5.
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
BB36F5 813 DOES THIS CHANGE AFTER YOU HAVE REACHED A SPECIFIED AMOUNT?
____________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP BB36G5
BB36G5 814-817 HOW DOES IT CHANGE?
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN BB1; OR CODED 2, 7, 8 OR 9 IN BB365
OR CODED 2, 7, 8 OR 9 IN BB36F5.
0001 = INSURANCE PAYS 100% AFTER SPECIFIED AMOUNT
0002 = LIFETIME LIMIT SPECIFIED
0003 = INSURANCE PAYS 100% UP TO LIFETIME MAXIMUM/YEARLY MAXIMUM
0004 = SPECIFIED TIME LIMIT OR NUMBER OF TIMES/THEN PATIENT MUST PAY
0005 = LIMIT GIVEN BUT NOT SPECIFIED IF YEARLY/LIFETIME
0006 = INSURANCE PAYS 80% UP TO LIMIT
0007 = INSURANCE PAYS UP TO USUAL AND CUSTOMARY PATIENT PAYS REST
0008 = YEARLY MAXIMUM SPECIFIED
0009 = INSURANCE PAYS 100% UP TO LIMIT
0010 = 90% OF USUAL AND CUSTOMARY
0011 = PREAPPROVED - 100%
0012 = INSURANCE PAYS 100% TO LIMIT THEN 80%
9991 = OTHER SPECIFIED
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
(130)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
INDEX OF VARIABLES PAGE 001
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== A =====
ADM2 035-036 Record 01 003
AMBVS2 040-042 Record 01 003
===== B =====
B_NONMED (314-337) Record 01 052
BABOXA1 (121-123) Record 01 015
BABOXA1A 121 Record 01 015
BABOXA1B 122 Record 01 015
BABOXA1C 123 Record 01 015
BA1 (055-120) Record 01 004
BA1AGE1 062-063 Record 01 005
BA1AGE10 116-117 Record 01 014
BA1AGE2 068-069 Record 01 006
BA1AGE3 074-075 Record 01 007
BA1AGE4 080-081 Record 01 008
BA1AGE5 086-087 Record 01 009
BA1AGE6 092-093 Record 01 010
BA1AGE7 098-099 Record 01 011
BA1AGE8 104-105 Record 01 012
BA1AGE9 110-111 Record 01 013
BA1CT 119-120 Record 01 015
BA1RELP 055-056 Record 01 004
BA1REL1 059-060 Record 01 005
BA1REL10 113-114 Record 01 014
BA1REL2 065-066 Record 01 006
BA1REL3 071-072 Record 01 007
BA1REL4 077-078 Record 01 008
BA1REL5 083-084 Record 01 009
BA1REL6 089-090 Record 01 010
BA1REL7 095-096 Record 01 011
BA1REL8 101-102 Record 01 012
BA1REL9 107-108 Record 01 013
BA1SEXP 057 Record 01 004
BA1SEX1 061 Record 01 005
BA1SEX10 115 Record 01 014
BA1SEX2 067 Record 01 006
BA1SEX3 073 Record 01 007
BA1SEX4 079 Record 01 008
BA1SEX5 085 Record 01 009
BA1SEX6 091 Record 01 010
BA1SEX7 097 Record 01 011
BA1SEX8 103 Record 01 012
BA1SEX9 109 Record 01 013
BA1SSTP 058 Record 01 004
INDEX OF VARIABLES PAGE 002
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BA1SST1 064 Record 01 005
BA1SST10 118 Record 01 014
BA1SST2 070 Record 01 006
BA1SST3 076 Record 01 007
BA1SST4 082 Record 01 008
BA1SST5 088 Record 01 009
BA1SST6 094 Record 01 010
BA1SST7 100 Record 01 011
BA1SST8 106 Record 01 012
BA1SST9 112 Record 01 013
BA10 150-155 Record 01 020
BA11 156 Record 01 020
BA12 (157-163) Record 01 020
BA12A 157 Record 01 021
BA12B 158 Record 01 021
BA12C 159 Record 01 021
BA12D 160 Record 01 021
BA12E 161 Record 01 022
BA12EOS 162-163 Record 01 022
BA13 164-165 Record 01 023
BA2 124 Record 01 015
BA3 125 Record 01 016
BA4 126 Record 01 016
BA5 127-128 Record 01 016
BA6 (129-134) Record 01 017
BA6A 129 Record 01 017
BA6B 130 Record 01 017
BA6C 131 Record 01 017
BA6D 132 Record 01 017
BA6E 133 Record 01 018
BA6F 134 Record 01 018
BA7 (135-138) Record 01 018
BA7MO 135-136 Record 01 018
BA7YR 137-138 Record 01 018
BA8 (139-142) Record 01 019
BA8MO 139-140 Record 01 019
BA8YR 141-142 Record 01 019
BA9PROV 143-149 Record 01 019
BBBOX1 (166-172) Record 01 023
BBBOX1A 166 Record 01 023
BBBOX1B 167 Record 01 023
BBBOX1C 168 Record 01 023
BBBOX1D 169 Record 01 024
BBBOX1E 170 Record 01 024
BBBOX1F 171 Record 01 024
INDEX OF VARIABLES PAGE 003
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BBBOX1G 172 Record 01 024
BBBOX2 174 Record 01 024
BBBOX3 175 Record 01 025
BBBOX4 195 Record 01 029
BBBOX5 218 Record 01 035
BBBOX6 227 Record 01 037
BBBOX7 228 Record 01 037
BBBOX8 247 Record 01 042
BBDAYS1 727-729 Record 01 119
BBINS1 717-719 Record 01 119
BBINS2 741-743 Record 01 122
BBINS3 761-763 Record 01 124
BBINS4 781-783 Record 01 127
BBINS5 804-806 Record 01 129
BBR1 714-716 Record 01 118
BBR2 738-740 Record 01 121
BBR3 758-760 Record 01 124
BBR4 778-780 Record 01 127
BBR5 801-803 Record 01 129
BB1 173 Record 01 024
BB10 203 Record 01 031
BB12 204 Record 01 031
BB13 205 Record 01 031
BB14 (206-217) Record 01 032
BB14A 206 Record 01 032
BB14B 207 Record 01 032
BB14C 208 Record 01 032
BB14D 209 Record 01 033
BB14E 210 Record 01 033
BB14F 211 Record 01 033
BB14G 212 Record 01 033
BB14H 213 Record 01 034
BB14I 214 Record 01 034
BB14J 215 Record 01 034
BB14K 216 Record 01 034
BB14L 217 Record 01 035
BB16 (219-222) Record 01 035
BB16MO 219-220 Record 01 035
BB16YR 221-222 Record 01 035
BB17 223 Record 01 036
BB18 224 Record 01 036
BB19 225 Record 01 036
BB2 176 Record 01 025
BB21 226 Record 01 036
BB22 229 Record 01 037
INDEX OF VARIABLES PAGE 004
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BB23 230 Record 01 037
BB24 (231-242) Record 01 038
BB24A 231 Record 01 038
BB24B 232 Record 01 038
BB24C 233 Record 01 038
BB24D 234 Record 01 039
BB24E 235 Record 01 039
BB24F 236 Record 01 039
BB24G 237 Record 01 039
BB24H 238 Record 01 040
BB24I 239 Record 01 040
BB24J 240 Record 01 040
BB24K 241 Record 01 040
BB24L 242 Record 01 041
BB25 (243-246) Record 01 041
BB25MO 243-244 Record 01 041
BB25YR 245-246 Record 01 041
BB26 248-249 Record 01 042
BB27 (250-253) Record 01 042
BB27MO 250-251 Record 01 042
BB27YR 252-253 Record 01 043
BB28 254 Record 01 043
BB29 255 Record 01 043
BB3 177 Record 01 025
BB31 (256-261) Record 01 043
BB31A (256-258) Record 01 043
BB31A1 256-257 Record 01 044
BB31A2 258 Record 01 044
BB31B (259-261) Record 01 044
BB31B1 259-260 Record 01 044
BB31B2 261 Record 01 045
BB32 696-701 Record 01 116
BB33 702-703 Record 01 116
BB34 704 Record 01 117
BB35 (705-710) Record 01 117
BB35A 705-709 Record 01 117
BB35B 710 Record 01 117
BB36AMT4 (791-797) Record 01 127
BB36A1 712 Record 01 118
BB36A2 736 Record 01 121
BB36A3 756 Record 01 123
BB36A4 776 Record 01 126
BB36A5 799 Record 01 128
BB36B1 713 Record 01 118
BB36B2 737 Record 01 121
INDEX OF VARIABLES PAGE 005
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BB36B3 757 Record 01 124
BB36B4 777 Record 01 126
BB36B5 800 Record 01 129
BB36C1 (714-719) Record 01 118
BB36C2 (738-743) Record 01 121
BB36C3 (758-763) Record 01 124
BB36C4 (778-783) Record 01 126
BB36C5 (801-806) Record 01 129
BB36DOL 791-796 Record 01 128
BB36D1 720-725 Record 01 119
BB36D2 744-749 Record 01 122
BB36D3 764-769 Record 01 125
BB36D4 784-789 Record 01 127
BB36D5 807-812 Record 01 130
BB36E1 726 Record 01 119
BB36E4 790 Record 01 127
BB36F1 730 Record 01 120
BB36F2 750 Record 01 122
BB36F3 770 Record 01 125
BB36F5 813 Record 01 130
BB36G1 731-734 Record 01 120
BB36G2 751-754 Record 01 123
BB36G3 771-774 Record 01 125
BB36G5 814-817 Record 01 130
BB36MAX 797 Record 01 128
BB361 711 Record 01 117
BB361E (726-729) Record 01 119
BB362 735 Record 01 120
BB363 755 Record 01 123
BB364 775 Record 01 126
BB365 798 Record 01 128
BB4 (178-189) Record 01 025
BB4A 178 Record 01 026
BB4B 179 Record 01 026
BB4C 180 Record 01 026
BB4D 181 Record 01 026
BB4E 182 Record 01 027
BB4F 183 Record 01 027
BB4G 184 Record 01 027
BB4H 185 Record 01 027
BB4I 186 Record 01 028
BB4J 187 Record 01 028
BB4K 188 Record 01 028
BB4L 189 Record 01 028
BB5 (190-193) Record 01 029
INDEX OF VARIABLES PAGE 006
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BB5MO 190-191 Record 01 029
BB5YR 192-193 Record 01 029
BB6 194 Record 01 029
BB7 196 Record 01 030
BB8 197-198 Record 01 030
BB9 (199-202) Record 01 030
BB9MO 199-200 Record 01 030
BB9YR 201-202 Record 01 031
BCAREACS (484) Record 01 075
BDNTLSRV (338-342) Record 01 055
BDRGSECT (343-427) Record 01 056
BD06CT 265-266 Record 01 045
BD1A 262 Record 01 045
BD1B 263-264 Record 01 045
BEMPLYMT (588-684) Record 01 095
BENDDT (023-028) Record 01 002
BENDDY 025-026 Record 01 002
BENDMO 023-024 Record 01 002
BENDYR 027-028 Record 01 002
BE08CT 270-271 Record 01 046
BE1A 267 Record 01 046
BE1B 268-269 Record 01 046
BFUNCTN (428-483) Record 01 064
BF1 272 Record 01 046
BF1A 273-274 Record 01 047
BF1ACT 275-276 Record 01 047
BF2 277 Record 01 047
BF2A 278-279 Record 01 047
BF2ACT 280-281 Record 01 047
BF3 282 Record 01 048
BF3A 283-284 Record 01 048
BF3ACT 285-286 Record 01 048
BF4 287 Record 01 048
BF4A 288-289 Record 01 048
BF4ACT 290-291 Record 01 049
BG1 292 Record 01 049
BG1A 293-294 Record 01 049
BG1ACT 295-296 Record 01 049
BG2 297 Record 01 050
BG2A 298-299 Record 01 050
BG2ACT 300-301 Record 01 050
BG3 302 Record 01 050
BG3A 303-304 Record 01 050
BG3ACT 305-306 Record 01 051
BG4 307 Record 01 051
INDEX OF VARIABLES PAGE 007
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BG4ACT 308-309 Record 01 051
BHACT 312-313 Record 01 052
BHOMHLTH (310-313) Record 01 051
BHSEHOLD (055) Record 01 004
BH1 310 Record 01 051
BH2 311 Record 01 052
BINSCOVR (166-261) Record 01 023
BINTOBS (684-695) Record 01 113
BIPSTAYS (262-266) Record 01 045
BITYPE 014 Record 01 001
BI1 314 Record 01 052
BI1CT 315-316 Record 01 052
BI2 317 Record 01 053
BI2CT 318-319 Record 01 053
BI3 320 Record 01 053
BI3CT 321-322 Record 01 053
BI4 323 Record 01 053
BI4CT 324-325 Record 01 054
BI5 326 Record 01 054
BI5CT 327-328 Record 01 054
BI6 329 Record 01 054
BI6CT 330-331 Record 01 054
BI7 332 Record 01 055
BI7CT 333-334 Record 01 055
BI8 335 Record 01 055
BI8CT 336-337 Record 01 055
BJ1 338 Record 01 056
BJ1A 339-340 Record 01 056
BJ1ACT 341-342 Record 01 056
BKACT 345-346 Record 01 057
BK1 343 Record 01 056
BK2 344 Record 01 057
BK3 347 Record 01 057
BK3CT 348-349 Record 01 057
BK4 (350-421) Record 01 057
BK4A 350-352 Record 01 058
BK4B 353-355 Record 01 058
BK4C 356-358 Record 01 058
BK4D 359-361 Record 01 058
BK4E 362-364 Record 01 059
BK4F 365-367 Record 01 059
BK4G 368-370 Record 01 059
BK4H 371-373 Record 01 059
BK4I 374-376 Record 01 060
BK4J 377-379 Record 01 060
INDEX OF VARIABLES PAGE 008
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BK4K 380-382 Record 01 060
BK4L 383-385 Record 01 060
BK4M 386-388 Record 01 061
BK4N 389-391 Record 01 061
BK4O 392-394 Record 01 061
BK4P 395-397 Record 01 061
BK4Q 398-400 Record 01 062
BK4R 401-403 Record 01 062
BK4S 404-406 Record 01 062
BK4T 407-409 Record 01 062
BK4U 410-412 Record 01 063
BK4V 413-415 Record 01 063
BK4W 416-418 Record 01 063
BK4X 419-421 Record 01 063
BK5 422-427 Record 01 064
BLANG 016 Record 01 001
BLBOX1 470-471 Record 01 074
BL1 428 Record 01 064
BL10 (457-461) Record 01 071
BL10A 457 Record 01 071
BL10B 458 Record 01 071
BL10C 459 Record 01 072
BL10D 460 Record 01 072
BL10E 461 Record 01 072
BL11 462-463 Record 01 073
BL12 464 Record 01 073
BL13 465 Record 01 073
BL14 466-467 Record 01 073
BL15 468-469 Record 01 073
BL16 (472-477) Record 01 074
BL16A 472-473 Record 01 074
BL16B 474-475 Record 01 074
BL16C 476-477 Record 01 074
BL17 (478-483) Record 01 075
BL17A 478-479 Record 01 075
BL17B 480-481 Record 01 075
BL17C 482-483 Record 01 075
BL2 (429-444) Record 01 064
BL2A 429 Record 01 064
BL2B 430 Record 01 065
BL2C 431 Record 01 065
BL2D 432 Record 01 065
BL2E 433 Record 01 065
BL2F 434 Record 01 065
BL2G 435 Record 01 066
INDEX OF VARIABLES PAGE 009
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BL2H 436 Record 01 066
BL2I 437 Record 01 066
BL2J 438 Record 01 066
BL2K 439 Record 01 066
BL2L 440 Record 01 067
BL2M 441 Record 01 067
BL2N 442 Record 01 067
BL2O 443 Record 01 067
BL2P 444 Record 01 067
BL3 (445-450) Record 01 068
BL3A 445 Record 01 068
BL3B 446 Record 01 068
BL3C 447 Record 01 068
BL3D 448 Record 01 068
BL3E 449 Record 01 069
BL3F 450 Record 01 069
BL4 451 Record 01 069
BL5 452 Record 01 069
BL6 453 Record 01 070
BL7 454 Record 01 070
BL8 455 Record 01 070
BL9 456 Record 01 071
BMEDVIST (272-291) Record 01 046
BM1 484 Record 01 076
BM2 (485-493) Record 01 076
BM2A 485-486 Record 01 076
BM2PROV 487-493 Record 01 076
BM3 494 Record 01 077
BM4 495 Record 01 077
BM5 496-497 Record 01 077
BM6 (498-502) Record 01 077
BM6HRS 501-502 Record 01 078
BM6MIN 498-500 Record 01 078
BM7 503 Record 01 078
BM8 (504-507) Record 01 078
BM8MOS 504-505 Record 01 078
BM8YRS 506-507 Record 01 079
BM9 (508-587) Record 01 079
BM9AA 508 Record 01 079
BM9AB 509 Record 01 079
BM9AC 510 Record 01 080
BM9AD 511 Record 01 080
BM9AE 512 Record 01 080
BM9AF 513 Record 01 080
BM9AG 514-517 Record 01 081
INDEX OF VARIABLES PAGE 010
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BM9BA 518 Record 01 081
BM9BB 519 Record 01 081
BM9BC 520 Record 01 082
BM9BD 521 Record 01 082
BM9BE 522 Record 01 082
BM9BF 523 Record 01 082
BM9BG 524-527 Record 01 083
BM9CA 528 Record 01 083
BM9CB 529 Record 01 083
BM9CC 530 Record 01 084
BM9CD 531 Record 01 084
BM9CF 532 Record 01 084
BM9CG 533-536 Record 01 085
BM9DA 537 Record 01 085
BM9DB 538 Record 01 085
BM9DC 539 Record 01 086
BM9DD 540 Record 01 086
BM9DE 541 Record 01 086
BM9DF 542 Record 01 086
BM9DG 543-546 Record 01 087
BM9EA 547 Record 01 087
BM9EB 548 Record 01 087
BM9EC 549 Record 01 088
BM9ED 550 Record 01 088
BM9EE 551 Record 01 088
BM9EF 552 Record 01 088
BM9EG 553-556 Record 01 089
BM9FA 557 Record 01 089
BM9FB 558 Record 01 089
BM9FC 559 Record 01 090
BM9FD 560 Record 01 090
BM9FE 561 Record 01 090
BM9FF 562 Record 01 090
BM9FG 563-566 Record 01 091
BM9GA 567 Record 01 091
BM9GB 568 Record 01 091
BM9GC 569 Record 01 092
BM9GD 570 Record 01 092
BM9GE 571 Record 01 092
BM9GF 572 Record 01 092
BM9GG 573-576 Record 01 093
BM9HA 577 Record 01 093
BM9HB 578 Record 01 093
BM9HC 579 Record 01 094
BM9HD 580 Record 01 094
INDEX OF VARIABLES PAGE 011
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BM9HE 581 Record 01 094
BM9HF 582 Record 01 094
BM9HG 583-586 Record 01 095
BM9IA 587 Record 01 095
BNBOX1 589 Record 01 096
BNBOX2 590 Record 01 096
BNBOX3 650 Record 01 107
BNBOX4 659 Record 01 109
BNURSHOM (267-271) Record 01 045
BN1 588 Record 01 095
BN10 610 Record 01 099
BN11 611-612 Record 01 099
BN12 613 Record 01 099
BN13 (614-617) Record 01 100
BN13MO 614-615 Record 01 100
BN13YR 616-617 Record 01 100
BN14 618 Record 01 100
BN15 619-620 Record 01 101
BN16 621-623 Record 01 101
BN17N18 624-627 Record 01 101
BN18A 628 Record 01 102
BN19 629 Record 01 102
BN2 591-593 Record 01 096
BN20 630 Record 01 102
BN21 631-632 Record 01 103
BN22 633 Record 01 103
BN23 634-635 Record 01 103
BN24 636 Record 01 104
BN25 (637-640) Record 01 104
BN25MO 637-638 Record 01 104
BN25YR 639-640 Record 01 104
BN26 641 Record 01 105
BN27 642-643 Record 01 105
BN28 644 Record 01 105
BN29 645 Record 01 106
BN3N4 594-597 Record 01 096
BN30 646-647 Record 01 106
BN31 648-649 Record 01 107
BN32 651 Record 01 107
BN33 (652-656) Record 01 107
BN33BX 656 Record 01 108
BN33DT (652-655) Record 01 108
BN33MO 652-653 Record 01 108
BN33YR 654-655 Record 01 108
BN34 657 Record 01 109
INDEX OF VARIABLES PAGE 012
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BN35 658 Record 01 109
BN36 660 Record 01 109
BN37 (661-665) Record 01 110
BN37BX 665 Record 01 110
BN37DT (661-664) Record 01 110
BN37MO 661-662 Record 01 110
BN37YR 663-664 Record 01 110
BN38 666 Record 01 111
BN39 (667-671) Record 01 111
BN39BX 671 Record 01 112
BN39DT (667-670) Record 01 111
BN39MO 667-668 Record 01 111
BN39YR 669-670 Record 01 111
BN4A 598 Record 01 097
BN40 672 Record 01 112
BN41 (673-676) Record 01 112
BN41MO 673-674 Record 01 112
BN41YR 675-676 Record 01 112
BN42 677 Record 01 113
BN43 678-683 Record 01 113
BN5 599 Record 01 097
BN6 600-601 Record 01 097
BN7 602-604 Record 01 098
BN8N9 605-608 Record 01 098
BN9A 609 Record 01 098
BOTHPROV (292-311) Record 01 049
BPID01 001-009 Record 01 001
BPIWSEC (696) Record 01 116
BP1 684 Record 01 113
BP2 685-686 Record 01 114
BP3 687 Record 01 114
BP4 688-689 Record 01 114
BP5 (690-695) Record 01 114
BP5A 690 Record 01 114
BP5B 691 Record 01 115
BP5C 692 Record 01 115
BP5D 693 Record 01 115
BP5E 694 Record 01 115
BP5F 695 Record 01 116
BREC01 010-011 Record 01 001
BREFDT (017-022) Record 01 001
BREFDY 019-020 Record 01 002
BREFMO 017-018 Record 01 001
BREFYR 021-022 Record 01 002
BRTYPE 015 Record 01 001
INDEX OF VARIABLES PAGE 013
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== B =====
BSREC01 012-013 Record 01 001
===== E =====
ERVS2 043-045 Record 01 003
===== G =====
GAP2FLAG 034 Record 01 003
===== H =====
HCVS2 046-048 Record 01 003
===== I =====
IPNGT2 037-039 Record 01 003
===== M =====
MDVS2 052-054 Record 01 004
===== O =====
OBSDAYS2 031-033 Record 01 002
OCVS2 049-051 Record 01 003
===== P =====
PATIENT (055-058) Record 01 004
PERSON1 (059-064) Record 01 005
PERSON10 (113-118) Record 01 014
PERSON2 (065-070) Record 01 006
PERSON3 (071-076) Record 01 007
PERSON4 (077-082) Record 01 008
PERSON5 (083-088) Record 01 009
PERSON6 (089-094) Record 01 010
PERSON7 (095-100) Record 01 011
PERSON8 (101-106) Record 01 012
PERSON9 (107-112) Record 01 013
===== T =====
T2_STAT 029-030 Record 01 002