/* SHORT TITLE: Codebook for Patient Quest-Time 3 Specific Data */
********************************************************************************
* W E S T A T C O D E B O O K *
* ----------- --------------- *
* *
* STUDY OF HEALTH CARE COSTS *
* WESTAT ADULT QUESTIONNAIRE TIME 3 - 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 3 - PUBLIC USE *
* 30 JUNE 1994 *
********************************************************************************
(0)
27 Jun. 1994
Record 01
STUDY OF HEALTH CARE COSTS
WESTAT ADULT QUESTIONNAIRE TIME 3 - PUBLIC USE
30 JUNE 1994
Question Column
Name Number(s)
________ _________
CPID01 001-009 PATIENT ID NUMBER
_________________
000000001-
999999999 = RANDOMLY ASSIGNED SEQUENTIAL NUMBER
CREC01 010-011 RECORD NUMBER
_____________
01 = NUMBER
CSREC01 012-013 SUBRECORD NUMBER
________________
00 = NOT A REPEATING RECORD
CITYPE 014 WHAT IS THE INSTRUMENT TYPE?
_____________________________
C = TIME 3 QUESTIONNAIRE
CRTYPE 015 RESPONDENT TYPE
_______________
1 = STUDY SUBJECT
2 = PROXY
IOANG 016 QUESTIONNAIRE LANGUAGE VERSION
______________________________
1 = ENGLISH
2 = SPANISH
CREFDT (017-022) REFERENCE BEGIN DATE
____________________
CREFMO 017-018 REFERENCE BEGIN MONTH
_____________________
01-12 = MONTH
(1)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CREFDY 019-020 REFERENCE BEGIN DAY
___________________
01-31 = DAY
CREFYR 021-022 REFERENCE BEGIN YEAR
____________________
91-92 = YEAR
CENDDT (023-028) REFERENCE END DATE
__________________
CENDMO 023-024 REFERENCE END MONTH
___________________
01-12 = MONTH
CENDDY 025-026 REFERENCE END DAY
_________________
01-31 = DAY
CENDYR 027-028 REFERENCE END YEAR
__________________
91-92 = YEAR
T3_STAT 029-030 QUESTIONNAIRE STATUS
____________________
CO = COMPLETE, WITH RESPONDENT
PR = COMPLETE, WITH PROXY
DD = COMPLETE, WITH PROXY PATIENT DECEASED AT TIME OF INTERVIEW
OBSDAYS3 031-033 OBSERVATION DAYS WITHIN REFERENCE PERIOD EXIOUDING PERIODS OF INELIGIBILITY
___________________________________________________________________________
001-600 = NUMBER
999 = NOT ASCERTAINED
(2)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
GAP3FLAG 034 PATIENT HAD TIME GAP DURING THE REFERENCE PERIOD
________________________________________________
+ = INAPPLICABLE, NO TIME GAP
1 = YES TIME GAP
ADM3 035-036 NUMBER OF INPATIENT ADMISSIONS (UNSTANDARDIZED)
_______________________________________________
00 = NONE
01-99 = NUMBER OF ADMISSIONS
IPNGT3 037-039 NUMBER OF INPATIENT NIGHTS (UNSTANDARDIZED)
___________________________________________
000 = NONE
001-999 = NUMBER OF NIGHTS
AMBVS3 040-042 NUMBER OF AMBULATORY VISITS, INCLUDES HOSPITAL CLINIC, OTHER CLINIC AND PRIVATE MD
(UNSTANDARDIZED)
________________
000 = NONE
001-999 = NUMBER OF AMBULATORY VISITS
ERVS3 043-045 NUMBER OF EMERGENCY ROOM VISITS (UNSTANDARDIZED)
________________________________________________
000 = NONE
001-999 = NUMBER OF EMERGENCY ROOM VISITS
HCVS3 046-048 NUMBER OF HOSPTIAL CLINIC VISITS (UNSTANDARDIZED)
_________________________________________________
000 = NONE
001-999 = NUMBER OF HOSPITAL CLINIC VISITS
OCVS3 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)
________ _________
MDVS3 052-054 NUMBER OF PRIVATE MD VISITS (UNSTANDARDIZED)
____________________________________________
000 = NONE
001-999 = NUMBER OF PRIVATE MD VISITS
CHSEHOLD (055-129) HOUSEHOLD COMPOSITION
_____________________
CA01CT 055-056 COUNTER OF PEOPLE LISTED IN Q.A1.
__________________________________
* 00 = NONE
01-99 = AMOUNT
* SKIP CA1REL1 - CA1SST10
PERSON1 (057-062) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL1 057-058 RELATIONSHIP
____________
+ = INAPPLICABLE, PATIENT LIVES ALONE
01-21 = USE CODES IN APPENDIX 55
91 = OTHER RELATIVE
92 = OTHER NON -RELATIVE
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CA1SEX1 059 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(4)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE1 060-061 AGE
___
+ = INAPPLICABLE, PATIENT LIVES ALONE
00 = NEWBORN TO 11 MONTHS
01-95 = YEARS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CA1SST1 062 HAS (PERSON) BEEN DIAGNOSED AS BEING HIV POSITIVE?
___________________________________________________
+ = INAPPLICABLE, PATIENT LIVES ALONE
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
PERSON2 (063-068) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL2 063-064 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
CA1SEX2 065 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(5)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE2 066-067 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
CA1SST2 068 HAS (PERSON) 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
PERSON3 (069-074) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL3 069-070 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
CA1SEX3 071 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(6)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE3 072-073 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
CA1SST3 074 HAS (PERSON) 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
PERSON4 (075-080) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL4 075-076 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
CA1SEX4 077 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(7)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE4 078-079 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
CA1SST4 080 HAS (PERSON) 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
PERSON5 (081-086) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL5 081-082 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
CA1SEX5 083 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(8)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE5 084-085 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
CA1SST5 086 HAS (PERSON) 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
PERSON6 (087-092) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL6 087-088 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
CA1SEX6 089 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(9)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE6 090-091 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
CA1SST6 092 HAS (PERSON) 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
PERSON7 (093-098) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL7 093-094 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
CA1SEX7 095 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(10)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE7 096-097 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
CA1SST7 098 HAS (PERSON) 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
PERSON8 (099-104) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL8 099-100 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
CA1SEX8 101 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(11)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE8 102-103 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
CA1SST8 104 HAS (PERSON) 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
PERSON9 (105-110) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL9 105-106 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
CA1SEX9 107 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(12)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE9 108-109 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
CA1SST9 110 HAS (PERSON) 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
PERSON10 (111-116) HOW IS THIS PERSON RELATED TO (PATIENT)? IS (PERSON) MALE OR FEMALE? HOW OLD IS
(PERSON)?
__________
CA1REL10 111-112 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
CA1SEX10 113 SEX
___
+ = INAPPLICABLE, PATIENT LIVES ALONE OR NO OTHER NAMES LISTED
1 = MALE
2 = FEMALE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(13)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA1AGE10 114-115 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
CA1SST10 116 HAS (PERSON) 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
CABOX1 (117-118) BOX A -1
________
CABOX1A 117 CHILDREN LISTED?
_________________
1 = YES
2 = NO
CABOX1B 118 SPOUSE/PARTNER LISTED?
_______________________
* 1 = YES
2 = NO
* SKIP CA2 - CA4
(14)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA2 119 ARE YOU CURRENTLY LEGALLY MARRIED, WIDOWED, DIVORCED, SEPARATED, OR HAVE YOU NEVER BEEN
MARRIED?
_________
+ = INAPPLICABLE, CODED 1 IN CABOX1B
* 1 = MARRIED
2 = WIDOWED
3 = DIVORCED
4 = SEPARATED
5 = NEVER MARRIED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
* SKIP CA3
CA3 120 ARE YOU CURRENTLY INVOLVED IN A COMMITTED RELATIONSHIP WITH ONE OTHER PERSON?
______________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CABOX1B; OR CODED 1 IN CA2
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CA4
CA4 121 HAS (YOUR SPOUSE/THAT PERSON) ALSO BEEN DIAGNOSED AS BEING HIV POSITIVE?
_________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CABOX1B; OR CODED 2, 7, 8 OR 9 IN CA3
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(15)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA5 122-123 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.
__________
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 OCCUPANCY (SRO) OR 'WELFARE HOTEL'
05 = SPECIALIZED AIDS HOUSING
06 = SHELTERS
07 = STREET OR OTHER PUBLIC PLACE
08 = HOSPITAL, NURSING HOME, RESIDENTIAL CARE FACILITY
09 = IN FOSTER HOMES APPENDIX 56
10 = LIVES WITH SOMEONE ELSE
11 = JAIL
12 = PUBLIC HOUSING
13 = TRAILER/HOUSE UNKNOWN IF OWNED/LEASED
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CA6 (124-129) 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).
CA6A 124 TEMPORARILY "DOUBLED UP" WITH FRIEND OR RELATIVE ON SOFA, FLOOR, ETC.
______________________________________________________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(16)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CA6B 125 SINGLE ROOM OCCUPANCY (SRO) OR 'WELFARE HOTEL'
______________________________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CA6C 126 SPECIALIZED AIDS HOUSING
________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CA6D 127 SHELTERS
________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CA6E 128 STREET OR OTHER PUBLIC PLACE
____________________________
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CA6F 129 NONE
____
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(17)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CINSCOVR (130-219) INSURANCE COVERAGE
__________________
CB1 130 SINCE (REF. DATE), HAVE YOU BEEN COVERED BY ANY PRIVATE HEALTH INSURANCE PLAN, INIOUDING
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 CBBOX2
CBBOX2 131 TIME 2 = PRIVATE INSURANCE
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB1
* 1 = YES
** 2 = NO
* SKIP CBBOX3
** SKIP CBBOX3 - CB6
CBBOX3 132 TIME 2 = PRIVATE INSURANCE
__________________________
+ = INAPPLICABLE, CODED 1 IN CB1
* 1 = YES
** 2 = NO
* SKIP CB2 - CB4L
** SKIP CB2 - CB10
(18)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB2 133 IS THIS THE SAME PRIVATE HEALTH INSURANCE PLAN YOU TOLD ME ABOUT LAST TIME?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED CBBOX3.
1 = YES
* 2 = NO
* 7 = REFUSED
8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB3 - CB4L
CB3 134 HAVE YOU BEEN COVERED THE WHOLE TIME FROM (REF. DATE) UNTIL TODAY, OR ONLY PART OF THE
TIME?
______
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED CBBOX3; OR CODED 2, 7 OR 9 IN
CB2.
* 1 = THE WHOLE TIME
2 = PART OF THE TIME
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB4A - CB10
CB4 (135-146) 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 1 FOR ALL CIRCLED MONTH(S). CODE 2 FOR ALL UNCIRCLED
MONTH(S).
CB4A 135 JANUARY
_______
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(19)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB4B 136 FEBRUARY
________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4C 137 MARCH
_____
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4D 138 APRIL
_____
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4E 139 MAY
___
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(20)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB4F 140 JUNE
____
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4G 141 JULY
____
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4H 142 AUGUST
______
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4I 143 SEPTEMBER
_________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(21)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB4J 144 OCTOBER
_______
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4K 145 NOVEMBER
________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB4L 146 DECEMBER
________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED IN CBBOX3; OR CODED 2, 7 OR 9
IN CB2; OR CODED 1, 7, 8 OR 9 IN CB3.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GO TO CB12
CB5 (147-150) WHEN DID YOUR (PREVIOUS) HEALTH INSURANCE COVERAGE END?
CODER: IF CB5YR EQUALS 97, 98 OR 99, CODE 99 IN CB5MO.
(22)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB5MO 147-148 MONTH
_____
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED 2 IN CBBOX3; OR CODED 1 OR 8 IN
CB2
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CB5YR 149-150 YEAR
____
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED 2 IN CBBOX3; OR CODED 1 OR 8 IN
CB2
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CB6 151 WAS IT BECAUSE OF YOUR HIV INFECTION THAT THIS HAPPENED?
_________________________________________________________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED 2 IN CBBOX3; OR CODED 1 OR 8 IN
CB2
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CBBOX4 152 LOOK AT Q. B-1. R ANSWERED:
______________________________
+ = INAPPLICABLE, CODED 2 IN CBBOX2; OR CODED 2 IN CBBOX3; OR CODED 1 OR 8 IN
CB2
1 = YES
* 2 = NO
* SKIP CB7 - CB10
(23)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB7 153 IS YOUR CURRENT PLAN INDIVIDUAL OR FAMILY COVERAGE?
____________________________________________________
+ = INAPPLICABLE, CODED ONLY IF CBBOX2 = 2 OR CBBOX4 = 1.
1 = INDIVIDUAL PLAN
2 = FAMILY PLAN
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB8 154-155 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 CBBOX2 = 2 OR CBBOX4 = 1.
01 = EMPLOYER/FAMILY BUSINESS
02 = UNION
03 = INSURANCE COMPANY
04 = SPECIAL INTEREST GROUP
05 = PUBLIC ASSISTANCE
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CB9 (156-159) WHEN DID YOUR CURRENT HEALTH INSURANCE BEGIN?
CODER: IF CB9YR EQUALS 97, 98 OR 99, CODE 99 IN CB9MO.
CB9MO 156-157 MONTH
_____
+ = INAPPLICABLE, CODED ONLY IF CBBOX2 = 2 OR CBBOX4 = 1.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(24)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB9YR 158-159 YEAR
____
+ = INAPPLICABLE, CODED ONLY IF CBBOX2 = 2 OR CBBOX4 = 1.
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CB10 160 IS THIS PLAN A HEALTH MAINTENANCE ORGANIZATION OR HMO?
_______________________________________________________
+ = INAPPLICABLE, CODED ONLY IF CBBOX2 = 2 OR CBBOX4 = 1.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB12 161 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 CB13 - CB14L
CB13 162 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 CB12.
* 1 = THE WHOLE TIME
2 = PART OF THE TIME
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB14A - CB18
(25)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB14 (163-174) 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 1 FOR ALL CIRCLED MONTH(S). CODE 2 FOR ALL UNCIRCLED
MONTH(S).
CB14A 163 JANUARY
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14B 164 FEBRUARY
________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14C 165 MARCH
_____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(26)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB14D 166 APRIL
_____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14E 167 MAY
___
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14F 168 JUNE
____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14G 169 JULY
____
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(27)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB14H 170 AUGUST
______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14I 171 SEPTEMBER
_________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14J 172 OCTOBER
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB14K 173 NOVEMBER
________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(28)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB14L 174 DECEMBER
________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB12; OR CODED 1, 7, 8 OR 9 IN CB13.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GO TO CB19
CBBOX5 175 TIME 2 = MEDICAID
_________________
+ = INAPPLICABLE, CODED 1 IN CB12
1 = YES
* 2 = NO
* SKIP CB16MO - CB16YR
CB16 (176-179) WHEN DID YOUR (MEDICAID/STATE NAME FOR MEDICAID) COVERAGE END?
CODER: IF CB16YR EQUALS 97, 98 OR 99, CODE 99 IN CB16MO.
CB16MO 176-177 MONTH
_____
+ = INAPPLICABLE, CODED IN CB12; OR CODED 2 IN CBBOX5.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CB16YR 178-179 YEAR
____
+ = INAPPLICABLE, CODED IN CB12; OR CODED 2 IN CBBOX5.
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(29)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB17 180 HAVE YOU (RE-)APPLIED FOR MEDICAID?
____________________________________
+ = INAPPLICABLE, CODED 1 IN CB12.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB18
CB18 181 HAVE YOU BEEN TURNED DOWN FOR MEDICAID?
________________________________________
+ = INAPPLICABLE, CODED 1 IN CB12; OR CODED 2, 7, 8 OR 9 IN CB17.
1 = YES
2 = NO/ NO DECISION YET
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB19 182 ARE YOU NOW 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
CB21 183 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 CBBOX6
(30)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CBBOX6 184 TIME 2 = OTHER PUBLIC ASSISTANCE
________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB21.
* 1 = YES
** 2 = NO
* SKIP CBBOX7
** SKIP CBBOX7 - CBBOX8
CBBOX7 185 TIME 2 = OTHER PUBLIC ASSISTANCE
________________________________
+ = INAPPLICABLE, CODED 1 IN CB21.
* 1 = YES
** 2 = NO
* SKIP CB22 - CB24L
** SKIP CB22 - CB27YR
CB22 186 IS THIS THE SAME PUBLIC ASSISTANCE PROGRAM YOU TOLD ME ABOUT LAST TIME?
________________________________________________________________________
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB23 - CB24L
CB23 187 HAVE YOU BEEN COVERED THE WHOLE TIME FROM (REF. DATE) UNTIL TODAY, OR ONLY PART OF THE
TIME?
______
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22.
* 1 = THE WHOLE TIME
2 = PART OF THE TIME
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB24A - CB27YR
(31)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB24 (188-199) 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 1 FOR ALL CIRCLED MONTH(S). CODE 2 FOR ALL UNCIRCLED
MONTH(S).
CB24A 188 JANUARY
_______
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24B 189 FEBRUARY
________
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24C 190 MARCH
_____
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(32)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB24D 191 APRIL
_____
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24E 192 MAY
___
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24F 193 JUNE
____
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24G 194 JULY
____
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(33)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB24H 195 AUGUST
______
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24I 196 SEPTEMBER
_________
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24J 197 OCTOBER
_______
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB24K 198 NOVEMBER
________
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(34)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB24L 199 DECEMBER
________
+ = INAPPLICABLE, CODED 2 IN CBBOX6; OR CODED IN CBBOX7; OR CODED 2, 7, 8 OR
9 IN CB22; OR CODED 1, 7, 8 OR 9 IN CB23.
1 = CIRCLED
2 = NOT CIRCLED
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
GO TO CBBOX9
CB25 (200-203) (LAST TIME YOU TOLD ME YOU WERE COVERED BY SOME PUBLIC ASSISTANCE PROGRAM.) WHEN DID YOUR
COVERAGE UNDER THAT PROGRAM END?
CODER: IF CB25YR EQUALS 97, 98 OR 99, CODE 99 IN CB25MO.
CB25MO 200-201 MONTH
_____
+ = INAPPLICABLE, CODED ONLY IF CBBOX7 = 1 OR CBB22 = 2, 7, 8 OR 9
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CB25YR 202-203 YEAR
____
+ = INAPPLICABLE, CODED ONLY IF CBBOX7 = 1 OR CBB22 = 2, 7, 8 OR 9
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(35)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CBBOX8 204 LOOK AT Q B-21. R ANSWERED:
_____________________________
+ = INAPPLICABLE, CODED ONLY IF CBBOX7 = 1 OR CBB22 = 2, 7, 8 OR 9
1 = YES
* 2 = NO
* SKIP CB26 - CB27YR
CB26 205-206 WHAT IS THE NAME OF THIS CURRENT PROGRAM?
__________________________________________
+ = INAPPLICABLE = CODED ONLY IF CBBOX6 = 2 OR CBBOX8 = 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
CB27 (207-210) WHEN DID YOUR COVERAGE UNDER THIS CURRENT PROGRAM BEGIN?
CODER: IF CB27YR EQUALS 97, 98 OR 99, CODE 99 IN CB27MO.
CB27MO 207-208 MONTH
_____
+ = INAPPLICABLE = CODED ONLY IF CBBOX6 = 2 OR CBBOX8 = 1
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(36)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB27YR 209-210 YEAR
____
+ = INAPPLICABLE = CODED ONLY IF CBBOX6 = 2 OR CBBOX8 = 1
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CBBOX9 211 TIME 2 - CHAMPUS/CHAMPVA
________________________
1 = YES
* 2 = NO
* SKIP CB28
CB28 212 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)?
__________________________________
+ = INAPPLICABLE, CODED 2 IN CBBOX9
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB29 213 ARE YOU CURRENTLY PARTICIPATING IN ANY CLINICAL TRIALS FOR ANY MEDICATIONS?
____________________________________________________________________________
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CB31A1 - CB31B2
CB31 (214-219) HOW LONG HAVE YOU BEEN PARTICIPATING IN THIS/THESE TRIALS?
___________________________________________________________
(37)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB31A (214-216) LENGTH OF TIME IN FIRST TRIAL
_____________________________
CB31A1 214-215 LENGTH OF FIRST TRIAL
_____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB29.
01-90 = AMOUNT
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
SKIP CB31A2
CB31A2 216 UNIT OF FIRST TRIAL
___________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB29; OR CODED 97, 98 OR 99 IN
CB31A1.
1 = DAYS
2 = WEEKS
3 = MONTHS
4 = YEARS
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CB31B (217-219) LENGTH OF TIME IN SECOND TRIAL
______________________________
CB31B1 217-218 LENGTH OF SECOND TRIAL
______________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB29.
01-90 = AMOUNT
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
SKIP CB31B2
(38)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CB31B2 219 UNIT OF SECOND TRIAL
____________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CB29; OR CODED 97, 98 OR 99 IN
CB31B1.
1 = DAYS
2 = WEEKS
3 = MONTHS
4 = YEARS
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CIPSTAYS (220-224) INPATIENT HOSPITAL STAYS
________________________
CD1A 220 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 CD1B
CD1B 221-222 HOW MANY TIMES HAVE YOU BEEN IN THE HOSPITAL OVERNIGHT OR LONGER SINCE (REF. DATE)?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CD1A.
01-96 = NUMBER OF TIMES
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CD05CT 223-224 NUMBER OF INPATIENT STAY RECORDS
________________________________
00 = NONE LISTED
01-99 = NUMBER
CNURSHOM (225-229) NURSING HOME/RESIDENTIAL CARE STAYS
___________________________________
(39)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CE1A 225 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 CE1B
CE1B 226-227 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 CE1A.
01-96 = NUMBER OF TIMES
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CE07CT 228-229 NUMBER OF NURSING HOME/RESIDENTIAL CARE RECORDS
_______________________________________________
00 = NONE LISTED
01-99 = NUMBER
CMEDVIST (230-249) MEDICAL VISITS
______________
CF1 230 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 CF1A
(40)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CF1A 231-232 HOW MANY DIFFERENT EMERGENCY ROOMS DID YOU VISIT SINCE (REF. DATE)?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CF1.
01-03 = NUMBER OF EMERGENCY ROOMS
CF09CT 233-234 NUMBER OF EMERGENCY ROOM RECORDS
________________________________
00 = NONE LISTED
01-99 = NUMBER
CF2 235 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 CF2A
CF2A 236-237 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 CF2.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CF10CT 238-239 NUMBER OF HOSPITAL CLINIC RECORDS
_________________________________
00 = NONE LISTED
01-99 = NUMBER
(41)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CF3 240 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 CF3A
CF3A 241-242 HOW MANY DIFFERENT MEDICAL CLINICS DID YOU VISIT SINCE (REF. DATE)?
_____________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CF3.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CF11CT 243-244 NUMBER OF MEDICAL CLINIC RECORDS
________________________________
00 = NONE LISTED
01-99 = NUMBER
CF4 245 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 CF4A
(42)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CF4A 246-247 HOW MANY DIFFERENT PRIVATE DOCTOR'S OFFICES DID YOU VISIT SINCE (REF. DATE)?
______________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CF4.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CF12CT 248-249 NUMBER OF PRIVATE DOCTOR'S OFFICE RECORDS
_________________________________________
00 = NONE LISTED
01-99 = NUMBER
COTHPROV (250-267) OTHER HEALTH CARE PROVIDERS
___________________________
CG1 250 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 CG1A
CG1A 251-252 HOW MANY DIFFERENT SUPPORT GROUPS OR PSYCHOLOGICAL COUNSELORS DID YOU VISIT SINCE (REF.
DATE)?
_______
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CG1.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(43)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CG13CT 253-254 NUMBER OF MENTAL HEALTH PROVIDER RECORDS
________________________________________
00 = NONE LISTED
01-99 = NUMBER
CG2 255 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 CG2A
CG2A 256-257 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 CG2.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CG14CT 258-259 NUMBER OF MEDICAL PRACTITIONER RECORDS
______________________________________
00 = NONE LISTED
01-99 = NUMBER
CG3 260 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 CG3A
(44)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CG3A 261-262 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 CG3.
01-96 = NUMBER OF PROVIDERS
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CG15CT 263-264 NUMBER OF ALTERNATIVE THERAPIST RECORDS
_______________________________________
00 = NONE LISTED
01-99 = NUMBER
CG4 265 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
CG16CT 266-267 NUMBER OF MEDICAL EQUIPMENT PROVIDER RECORDS
____________________________________________
00 = NONE LISTED
01-99 = NUMBER
CHOMHLTH (268-271) HOME HEALTH CARE
________________
(45)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CH1 268 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. SINCE (REF. DATE), HAVE YOU RECEIVED ANY OF
THESE KINDS OF SERVICES AT HOME?
_________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CH2 269 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
CH18CT 270-271 NUMBER OF HOME HEALTH PROVIDER RECORDS
______________________________________
00 = NONE LISTED
01-99 = NUMBER
C_NONMED (272-292) NON - MEDICAL SERVICES
______________________
CI1 272 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
(46)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CI20CT 273-274 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH HOUSING
____________________________________________________
00 = NONE
01-99 = NUMBER
CI2 275 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
CI21CT 276-277 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH LEGAL SERVICES
___________________________________________________________
00 = NONE
01-99 = NUMBER
CI3 278 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
CI22CT 279-280 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH CHILD CARE
_______________________________________________________
00 = NONE
01-99 = NUMBER
(47)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CI4 281 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
CI23CT 282-283 NUMBER OF RECORDS FOR PROVIDERS WITH TRANSPORTATION
___________________________________________________
00 = NONE
01-99 = NUMBER
CI5 284 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, EITHER GROCERIES YOU WERE GIVEN OR MEALS YOU WERE SERVED OUTSIDE YOUR
HOME?
______
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CI24CT 285-286 NUMBER OF RECORDS FOR PROVIDERS OBTAIN FOOD
___________________________________________
00 = NONE
01-99 = NUMBER
CI6 287 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
(48)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CI25CT 288-289 NUMBER OF RECORDS FOR PROVIDERS HELPING WITH FINANCIAL ASSISTANCE
_________________________________________________________________
00 = NONE
01-99 = NUMBER
CI7 290 ARE YOU CURRENTLY RECEIVING TREATMENT OR COUNSELING FOR PROBLEMS RELATED TO ALCOHOL OR
DRUG USE?
__________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CI26CT 291-292 NUMBER OF RECORDS FOR ALCOHOL/DRUG TREATMENT PROVIDERS
______________________________________________________
00 = NONE
01-99 = NUMBER
CDNTLSRV (293-297) DENTAL SERVICES
_______________
CJ1 293 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 CJ1A
(49)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CJ1A 294-295 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 CJ1.
01-96 = NUMBER
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CJ28CT 296-297 NUMBER OF DENTAL VISIT RECORDS
______________________________
00 = NONE
01-99 = NUMBER
CDRGSECT (298-383) HIV - RELATED MEDICINES
_______________________
CK1 298 LAST TIME YOU TOLD ME THAT YOU WERE TAKING THESE PRESCRIBED MEDICINES. SINCE (REF.
DATE), HAVE YOU TAKEN, OR ARE YOU STILL TAKING ANY OR THE MEDICINES LISTED HERE?
_________________________________________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CK2 299 (OTHER THAN WHAT WE'VE ALREADY TALKED ABOUT) 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
(50)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK3 300 SINCE (REF. DATE), HAVE YOU TAKEN ANY OTHER PRESCRIPTION MEDICINES OR DRUGS?
______________________________________________________________________________
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CK30CT 301-302 NUMBER OF PRESCRIPTION DRUG RECORDS
___________________________________
00 = NONE LISTED
01-99 = NUMBER
CK4 303 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
CK31CT 304-305 NUMBER OF NON-PRESCRIPTION DRUGS/NON-TRADITIONAL SUBSTANCES Q C-K4
__________________________________________________________________
* 00 = NO DRUGS LISTED
01-99 = NUMBER OF DRUGS LISTED
* SKIP CK5A - CK6
CK5 (306-377) WHAT ARE THE NAMES OF THE NON-PRESCRIPTION DRUGS OR NON-TRADITIONAL SUBSTANCES THAT YOU
ARE TAKING?
____________
(51)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK5A 306-308 NON - PRESCRIPTION DRUG 1
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT.
001-720 = USE CODES IN APPENDIX 28
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
CK5B 309-311 NON - PRESCRIPTION DRUG 2
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5C 312-314 NON - PRESCRIPTION DRUG 3
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5D 315-317 NON - PRESCRIPTION DRUG 4
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
(52)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK5E 318-320 NON - PRESCRIPTION DRUG 5
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5F 321-323 NON - PRESCRIPTION DRUG 6
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5G 324-326 NON - PRESCRIPTION DRUG 7
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5H 327-329 NON - PRESCRIPTION DRUG 8
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; OR NO
OTHER NON-PRESCRIPTION DRUG/SUBSTANCE LISTED.
001-720 = NON - PRESCRIPTION DRUG CODES
991 = OTHER SPECIFIED
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
(53)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK5I 330-332 NON - PRESCRIPTION DRUG 9
_________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5J 333-335 NON - PRESCRIPTION DRUG 10
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5K 336-338 NON - PRESCRIPTION DRUG 11
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5L 339-341 NON - PRESCRIPTION DRUG 12
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
(54)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK5M 342-344 NON - PRESCRIPTION DRUG 13
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5N 345-347 NON - PRESCRIPTION DRUG 14
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5O 348-350 NON - PRESCRIPTION DRUG 15
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5P 351-353 NON - PRESCRIPTION DRUG 16
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
(55)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK5Q 354-356 NON - PRESCRIPTION DRUG 17
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5R 357-359 NON - PRESCRIPTION DRUG 18
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5S 360-362 NON - PRESCRIPTION DRUG 19
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5T 363-365 NON - PRESCRIPTION DRUG 20
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
(56)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK5U 366-368 NON - PRESCRIPTION DRUG 21
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5V 369-371 NON - PRESCRIPTION DRUG 22
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5W 372-374 NON - PRESCRIPTION DRUG 23
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
CK5X 375-377 NON - PRESCRIPTION DRUG 24
__________________________
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4; AND CODED 00 IN CK31CT; 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
(57)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CK6 378-383 WE'RE INTERESTED IN THE TOTAL AMOUNT YOU SPENT ON (MEDICINE). HOW MUCH DID YOU PAY FOR
(MEDICINES IN Q K-5) SINCE (REF. DATE)?
CODER: CODE AMOUNTS IN WHOLE DOLLARS.
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CK4.
000000 = NOTHING
000001-999996 = AMOUNT
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
CEMPLYMT (384-480) EMPLOYMENT AND INCOME
_____________________
CL1 384 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 CLBOX1 - CLBOX2
** SKIP CLBOX1
CLBOX1 385 R CURRENTLY WORKING PART-TIME. LOOK AT FACE SHEETS. LAST TIME R WAS:
_______________________________________________________________________
+ = INAPPLICABLE, CODED 1, 3, 7, 8 OR 9 IN CL1
* 1 = WORKING FULL TIME (FT)
** 2 = WORKING PART -TIME (PT)
** 3 = NOT WORKING (NW)
* SKIP CLBOX2 - CL6
** SKIP CLBOX2 - CL15
(58)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CLBOX2 386 R CURRENTLY NOT WORKING. LOOK AT FACE SHEETS. LAST TIME R WAS:
_________________________________________________________________
+ = INAPPLICABLE, CODED 1 OR 2 IN CL1
* 1 = WORKING FULL TIME (FT)
* 2 = WORKING PART -TIME (PT)
** 3 = NOT WORKING (NW)
* SKIP CL2 - CL21
** SKIP CL2 - CL27
CL2 387-389 ABOUT HOW MANY HOURS DO YOU CURRENTLY WORK AT THIS JOB IN THE AVERAGE WEEK?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN CL1.
001-080 = HOURS PER WEEK
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
CL3L4 390-393 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 CL1.
0001-9990 = 1983 CENSUS OCCUPATIONAL CODE
9994 = UNCODEABLE
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
(59)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL4A 394 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 CL1.
1 = LESS THAN 25 PEOPLE
2 = 25 - 99 PEOPLE
3 = 100 - 499 PEOPLE
4 = 500 OR MORE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CL5 395 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 CL1.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL6 - CL30
CL6 396-397 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 2, 3, 7, 8 OR 9 IN CL1; OR CODED 2, 7, 8 OR 9 IN CL5
* 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 CL7 - CL30
(60)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL7 398-400 ABOUT HOW MANY HOURS DO YOU CURRENTLY WORK AT THIS JOB IN THE AVERAGE WEEK?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
001-050 = HOURS PER WEEK
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
CL8L9 401-404 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 CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
0001-9990 = 1983 CENSUS OCCUPATIONAL CODES
9994 = UNCODEABLE
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
CL9A 405 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 CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
1 = LESS THAN 25 PEOPLE
2 = 25 - 99 PEOPLE
3 = 100 - 499 PEOPLE
4 = 500 OR MORE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(61)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL10 406 ARE YOU ACTIVELY LOOKING FOR (FULL-TIME) WORK?
_______________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CL11 407-408 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 CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
01 = LEAVE OF ABSENCE/DISABILITY LEAVE
02 = QUIT
03 = LAID OFF
04 = FIRED
05 = TOO ILL
06 = PREGNANCY
07 = ARRESTED/PRISON
08 = RETIRED
09 = KEPT SAME JOB,CHANGED TO PART TIME
10 = MOVED
11 = JOB ENDED/BUSINESS CLOSED/MOVED/WAS SOLD
12 = SCHOOL
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL12 409 WAS IT BECAUSE OF YOUR HIV INFECTION THAT THIS HAPPENED?
_________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
(62)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL13 (410-413) IN WHAT MONTH AND YEAR DID YOU LEAVE THAT (FULL TIME) JOB?
CODER: IF CL13YR EQUALS 97, 98, 99 CODE 99 IN CL13MO.
CL13MO 410-411 MONTH THAT LEAVE BEGAN
______________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL13YR 412-413 YEAR THAT LEAVE BEGAN
_____________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL14 414 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 CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL15 - CL30
(63)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL15 415-416 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 2 OR 3 IN CLBOX1; OR CODED 1, 2 OR
3 IN CLBOX2; OR CODED 2, 7, 8 OR 9 IN CL14.
* 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 CL16 - CL30
CL16 417-419 ABOUT HOW MANY HOURS DO YOU CURRENTLY WORK AT THIS JOB IN THE AVERAGE WEEK?
____________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1 IN CLBOX1; OR CODED 1, 2 OR 3 IN
CLBOX2.
001-050 = HOURS PER WEEK
997 = REFUSED
998 = DK
999 = NOT ASCERTAINED
CL17L18 420-423 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 CL1; OR CODED 1 IN CLBOX1; OR CODED 1, 2 OR 3 IN
CLBOX2.
0001-9990 = 1983 CENSUS OCCUPATIONAL CODES
9994 = UNCODEABLE
9997 = REFUSED
9998 = DK
9999 = NOT ASCERTAINED
(64)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL18A 424 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 CL1; OR CODED 1 IN CLBOX1; OR CODED 1, 2 OR 3 IN
CLBOX2.
1 = LESS THAN 25 PEOPLE
2 = 25 - 99 PEOPLE
3 = 100 - 499 PEOPLE
4 = 500 OR MORE
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CL19 425 ARE YOU ACTIVELY LOOKING FOR FULL TIME WORK?
_____________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1 IN CLBOX1; OR CODED 1, 2 OR 3 IN
CLBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CL20 426 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 CL1; OR CODED 1 IN CLBOX1; OR CODED 1, 2 OR 3 IN
CLBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL21 - CL30
(65)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL21 427-428 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1 IN CLBOX1; OR CODED 1, 2 OR 3 IN
CLBOX2; OR CODED 2, 7, 8 OR 9 IN CL20.
* 01 = STOPPED QUIT WORKING/UNABLE TO WORK DUE TO HEALTH PROBLEMS
* 02 = CAN'T DO WHAT I USED TO DO
* 03 = CHANGE TYPE/ AMOUNT OF WORK
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP CL22 - CL30
CL22 429 ARE YOU ACTIVELY LOOKING FOR (FULL-TIME) WORK?
_______________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CL23 430-431 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 CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2.
01 = LEAVE OF ABSENCE/DISABILITY LEAVE
02 = QUIT
03 = LAID OFF
04 = FIRED
05 = TOO ILL
06 = PREGNANCY
07 = ARRESTED/PRISON
08 = RETIRED
09 = KEPT SAME JOB,CHANGED TO PART TIME
10 = MOVED,LEFT AREA
11 = JOB ENDED/BUSINESS CLOSED/MOVED/WAS SOLD
12 = SCHOOL
91 = OTHER SPECIFIED
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(66)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL24 432 WAS IT BECAUSE OF YOUR HIV INFECTION THAT THIS HAPPENED?
_________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2.
1 = YES
2 = NO
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CL25 (433-436) IN WHAT MONTH AND YEAR DID YOU LEAVE THAT JOB?
CODER: IF CL25YR EQUALS 97, 98, 99 CODE 99 IN CL25MO.
CL25MO 433-434 MONTH THAT LEAVE BEGAN
______________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL25YR 435-436 YEAR THAT LEAVE BEGAN
_____________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2.
89-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(67)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL26 437 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 CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL27 - CL30
CL27 438-439 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 3 IN
CLBOX2; OR CODED 2, 7, 8 OR 9 IN CL26.
* 01 = STOPPED QUIT WORKING/UNABLE TO WORK DUE TO HEALTH PROBLEMS
* 02 = CAN'T DO WHAT I USED TO DO
* 03 = CHANGE TYPE/AMOUNT OF WORK
* 91 = OTHER SPECIFIED
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP CL28 - CL30
CL28 440 ARE YOU ACTIVELY LOOKING FOR FULL TIME WORK?
_____________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 1 OR
2 IN CLBOX2.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL29 - CL30
(68)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL29 441 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 CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 1 OR
2 IN CLBOX2; OR CODED 2, 7, 8 OR 9 IN CL28.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL30
CL30 442-443 WHAT TYPE OF CHANGE(S) DID YOU MAKE? RECORD VERBATIM.
_______________________________________________________
+ = INAPPLICABLE, CODED 1 IN CL1; OR CODED 1, 2 OR 3 IN CLBOX1; OR CODED 1 OR
2 IN CLBOX2; OR CODED 2, 7, 8 OR 9 IN CL28; OR CODED 2, 7, 8 OR 9 IN
CL29.
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
(69)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL31 444-445 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
CLBOX3 446 R WORKING FULL TIME (Q.L-1)
___________________________
* 1 = YES
2 = NO
* SKIP CL32 - CL41YR
CL32 447 SINCE (REF. DATE), HAVE YOU RECEIVED ANY SOCIAL SECURITY DISABILITY PAYMENTS?
_______________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL33MO - CL33BX
CL33 (448-452) IN WHAT MONTH AND YEAR DID YOU RECEIVE YOUR FIRST SOCIAL SECURITY DISABILITY PAYMENT?
______________________________________________________________________________________
(70)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL33DT (448-451) DATE YOU RECEIVED FIRST SOCIAL SECURITY DISABILITY PAYMENT
CODER: IF CL33YR EQUALS 97, 98 OR 99 CODE 99 IN CL33MO.
CL33MO 448-449 MONTH YOU RECEIVED FIRST SOCIAL SECURITY DISABILITY PAYMENT
___________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL32; OR CODED
IN CL33BX.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL33YR 450-451 YEAR YOU RECEIVED FIRST SOCIAL SECURITY DISABILITY PAYMENT
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL32; OR CODED
IN CL33BX.
* 91-92 = YEAR
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP CL33BX
CL33BX 452 FIRST SOCIAL SECURITY DISABILITY PAYMENT BEFORE REFERENCE DATE
______________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL32; OR CODED
IN CL33DT.
* 1 = CHECKED
* SKIP CL34 - CL35
(71)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL34 453 HAVE YOU APPLIED FOR SOCIAL SECURITY DISABILITY PAYMENTS?
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 1 IN CL32.
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL35
CL35 454 HAVE YOU BEEN TURNED DOWN FOR SOCIAL SECURITY DISABILITY?
__________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 1 IN CL32; OR CODED 2, 7, 8 OR
9 IN CL34.
1 = YES
2 = NO/NO DECISION YET
7 = REFUSED
8 = DK
9 = NOT ASCERTAINED
CLBOX4 455 R HAS: CHILDREN (SEE FLAP)
___________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3.
* 1 = NO CHILDREN LIVING WITH THEM
2 = 1 OR MORE CHILDREN LIVING WITH THEM
* SKIP CL36 - CL37BX
CL36 456 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 CLBOX3; OR CODED 1 IN CLBOX4
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL37MO - CL37BX
(72)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL37 (457-461) IN WHAT MONTH AND YEAR DID YOU RECEIVE YOUR FIRST AFDC PAYMENT?
________________________________________________________________
CL37DT (457-460) DATE YOU RECEIVED YOUR FIRST AFDC PAYMENT
CODER: IF CL37YR EQUALS 97, 98, 99 CODE 99 IN CL37MO.
CL37MO 457-458 MONTH YOU RECEIVED YOUR FIRST AFDC PAYMENT
__________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 1 IN CLBOX4; OR CODED 2, 7, 8
OR 9 IN CL36; OR CODED IN CL37BX.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL37YR 459-460 YEAR YOU RECEIVED YOUR FIRST AFDC PAYMENT
_________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 1 IN CLBOX4; OR CODED 2, 7, 8
OR 9 IN CL36; OR CODED IN CL37BX.
* 91-92 = YEAR
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP CL37BX
CL37BX 461 FIRST AFDC PAYMENT BEFORE REFERENCE DATE
________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 1 IN CLBOX4; OR CODED 2, 7, 8
OR 9 IN CL36; OR CODED IN CL37DT.
1 = CHECKED
(73)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL38 462 SINCE (REF. DATE), HAVE YOU RECEIVED THE SUPPLEMENTAL SECURITY INCOME OR SSI CHECK?
_____________________________________________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL39MO - CL39BX
CL39 (463-467) IN WHAT MONTH DID YOU RECEIVE YOUR FIRST SSI PAYMENT?
______________________________________________________
CL39DT (463-466) DATE YOU RECEIVED YOUR FIRST SSI PAYMENT?
CODER: IF CL39YR EQUALS 97, 98 OR 99 CODE 99 IN CL39MO.
CL39MO 463-464 MONTH YOU RECEIVED YOUR FIRST SSI PAYMENT
_________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL38; OR CODED
IN CL39BX.
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL39YR 465-466 YEAR YOU RECEIVED YOUR FIRST SSI PAYMENT
________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL38; OR CODED
IN CL39BX.
* 91-92 = YEAR
* 97 = REFUSED
* 98 = DK
* 99 = NOT ASCERTAINED
* SKIP CL39BX
(74)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL39BX 467 FIRST SSI PAYMENT BEFORE REFERENCE DATE
_______________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED IN CL39DT.
1 = CHECKED
CL40 468 SINCE (REF. DATE), HAVE YOU RECEIVED FOOD STAMPS?
___________________________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3
1 = YES
* 2 = NO
* 7 = REFUSED
* 8 = DK
* 9 = NOT ASCERTAINED
* SKIP CL41MO - CL41YR
CL41 (469-472) IN WHAT MONTH DID YOU FIRST RECEIVE FOOD STAMPS?
CODER: IF CL41YR EQUALS 97, 98 OR 99 CODE 99 IN CL41MO.
CL41MO 469-470 MONTH YOU FIRST RECEIVED FOOD STAMPS
____________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL40
01-12 = MONTH
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
CL41YR 471-472 YEAR YOU FIRST RECEIVED FOOD STAMPS
___________________________________
+ = INAPPLICABLE, CODED 1 IN CLBOX3; OR CODED 2, 7, 8 OR 9 IN CL40
91-92 = YEAR
97 = REFUSED
98 = DK
99 = NOT ASCERTAINED
(75)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CL42 473 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 CL43
CL43 474-479 HOW MUCH HAVE YOU RECEIVED SINCE (REF. DATE)?
CODER: CODE AMOUNTS IN WHOLE DOLLARS
+ = INAPPLICABLE, CODED 2, 7, 8 OR 9 IN CL42
000001-999996 = AMOUNT RECEIVED
999997 = REFUSED
999998 = DK
999999 = NOT ASCERTAINED
CINTOBS (480-491) INTERVIEWER OBSERVATIONS
________________________
CN1 480 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 CN2
(76)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CN2 481-482 WHY?
_____
+ = INAPPLICABLE, CODED 1, 2, 8 OR 9 IN CN1
91 = FLAG FOR QUESTION ANSWERED
98 = DK
99 = NOT ASCERTAINED
CN3 483 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 CN4
CN4 484-485 WHY?
_____
+ = INAPPLICABLE, CODED 1, 2, 8 OR 9 IN CN3
91 = FLAG FOR QUESTION ANSWERED
98 = DK
99 = NOT ASCERTAINED
CN5 (486-491) GENERALLY THE RESPONDENT WAS:
______________________________
CN5A 486 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
(77)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CN5B 487 COOPERATIVE
___________
1-7 = DEGREE OF COOPERATION
CODER: CODE 1 = COOPERATIVE TO CODE 7 = UNCOOPERATIVE
8 = DK
9 = NOT ASCERTAINED
CN5C 488 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
CN5D 489 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
CN5E 490 SOBER
_____
1-7 = LEVEL OF SOBRIETY
CODER: CODE 1 = SOBER TO CODE 7 = INEBRIATED/HIGH
8 = DK
9 = NOT ASCERTAINED
(78)
27 Jun. 1994
Record 01
Question Column
Name Number(s)
________ _________
CN5F 491 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
(79)
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 =====
ADM3 035-036 Record 01 003
AMBVS3 040-042 Record 01 003
===== C =====
C_NONMED (272-292) Record 01 046
CABOX1 (117-118) Record 01 014
CABOX1A 117 Record 01 014
CABOX1B 118 Record 01 014
CA01CT 055-056 Record 01 004
CA1AGE1 060-061 Record 01 005
CA1AGE10 114-115 Record 01 014
CA1AGE2 066-067 Record 01 006
CA1AGE3 072-073 Record 01 007
CA1AGE4 078-079 Record 01 008
CA1AGE5 084-085 Record 01 009
CA1AGE6 090-091 Record 01 010
CA1AGE7 096-097 Record 01 011
CA1AGE8 102-103 Record 01 012
CA1AGE9 108-109 Record 01 013
CA1REL1 057-058 Record 01 004
CA1REL10 111-112 Record 01 013
CA1REL2 063-064 Record 01 005
CA1REL3 069-070 Record 01 006
CA1REL4 075-076 Record 01 007
CA1REL5 081-082 Record 01 008
CA1REL6 087-088 Record 01 009
CA1REL7 093-094 Record 01 010
CA1REL8 099-100 Record 01 011
CA1REL9 105-106 Record 01 012
CA1SEX1 059 Record 01 004
CA1SEX10 113 Record 01 013
CA1SEX2 065 Record 01 005
CA1SEX3 071 Record 01 006
CA1SEX4 077 Record 01 007
CA1SEX5 083 Record 01 008
CA1SEX6 089 Record 01 009
CA1SEX7 095 Record 01 010
CA1SEX8 101 Record 01 011
CA1SEX9 107 Record 01 012
CA1SST1 062 Record 01 005
CA1SST10 116 Record 01 014
CA1SST2 068 Record 01 006
CA1SST3 074 Record 01 007
CA1SST4 080 Record 01 008
INDEX OF VARIABLES PAGE 002
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CA1SST5 086 Record 01 009
CA1SST6 092 Record 01 010
CA1SST7 098 Record 01 011
CA1SST8 104 Record 01 012
CA1SST9 110 Record 01 013
CA2 119 Record 01 015
CA3 120 Record 01 015
CA4 121 Record 01 015
CA5 122-123 Record 01 016
CA6 (124-129) Record 01 016
CA6A 124 Record 01 016
CA6B 125 Record 01 017
CA6C 126 Record 01 017
CA6D 127 Record 01 017
CA6E 128 Record 01 017
CA6F 129 Record 01 017
CBBOX2 131 Record 01 018
CBBOX3 132 Record 01 018
CBBOX4 152 Record 01 023
CBBOX5 175 Record 01 029
CBBOX6 184 Record 01 031
CBBOX7 185 Record 01 031
CBBOX8 204 Record 01 036
CBBOX9 211 Record 01 037
CB1 130 Record 01 018
CB10 160 Record 01 025
CB12 161 Record 01 025
CB13 162 Record 01 025
CB14 (163-174) Record 01 026
CB14A 163 Record 01 026
CB14B 164 Record 01 026
CB14C 165 Record 01 026
CB14D 166 Record 01 027
CB14E 167 Record 01 027
CB14F 168 Record 01 027
CB14G 169 Record 01 027
CB14H 170 Record 01 028
CB14I 171 Record 01 028
CB14J 172 Record 01 028
CB14K 173 Record 01 028
CB14L 174 Record 01 029
CB16 (176-179) Record 01 029
CB16MO 176-177 Record 01 029
CB16YR 178-179 Record 01 029
CB17 180 Record 01 030
INDEX OF VARIABLES PAGE 003
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CB18 181 Record 01 030
CB19 182 Record 01 030
CB2 133 Record 01 019
CB21 183 Record 01 030
CB22 186 Record 01 031
CB23 187 Record 01 031
CB24 (188-199) Record 01 032
CB24A 188 Record 01 032
CB24B 189 Record 01 032
CB24C 190 Record 01 032
CB24D 191 Record 01 033
CB24E 192 Record 01 033
CB24F 193 Record 01 033
CB24G 194 Record 01 033
CB24H 195 Record 01 034
CB24I 196 Record 01 034
CB24J 197 Record 01 034
CB24K 198 Record 01 034
CB24L 199 Record 01 035
CB25 (200-203) Record 01 035
CB25MO 200-201 Record 01 035
CB25YR 202-203 Record 01 035
CB26 205-206 Record 01 036
CB27 (207-210) Record 01 036
CB27MO 207-208 Record 01 036
CB27YR 209-210 Record 01 037
CB28 212 Record 01 037
CB29 213 Record 01 037
CB3 134 Record 01 019
CB31 (214-219) Record 01 037
CB31A (214-216) Record 01 038
CB31A1 214-215 Record 01 038
CB31A2 216 Record 01 038
CB31B (217-219) Record 01 038
CB31B1 217-218 Record 01 038
CB31B2 219 Record 01 039
CB4 (135-146) Record 01 019
CB4A 135 Record 01 019
CB4B 136 Record 01 020
CB4C 137 Record 01 020
CB4D 138 Record 01 020
CB4E 139 Record 01 020
CB4F 140 Record 01 021
CB4G 141 Record 01 021
CB4H 142 Record 01 021
INDEX OF VARIABLES PAGE 004
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CB4I 143 Record 01 021
CB4J 144 Record 01 022
CB4K 145 Record 01 022
CB4L 146 Record 01 022
CB5 (147-150) Record 01 022
CB5MO 147-148 Record 01 023
CB5YR 149-150 Record 01 023
CB6 151 Record 01 023
CB7 153 Record 01 024
CB8 154-155 Record 01 024
CB9 (156-159) Record 01 024
CB9MO 156-157 Record 01 024
CB9YR 158-159 Record 01 025
CDNTLSRV (293-297) Record 01 049
CDRGSECT (298-383) Record 01 050
CD05CT 223-224 Record 01 039
CD1A 220 Record 01 039
CD1B 221-222 Record 01 039
CEMPLYMT (384-480) Record 01 058
CENDDT (023-028) Record 01 002
CENDDY 025-026 Record 01 002
CENDMO 023-024 Record 01 002
CENDYR 027-028 Record 01 002
CE07CT 228-229 Record 01 040
CE1A 225 Record 01 040
CE1B 226-227 Record 01 040
CF09CT 233-234 Record 01 041
CF1 230 Record 01 040
CF1A 231-232 Record 01 041
CF10CT 238-239 Record 01 041
CF11CT 243-244 Record 01 042
CF12CT 248-249 Record 01 043
CF2 235 Record 01 041
CF2A 236-237 Record 01 041
CF3 240 Record 01 042
CF3A 241-242 Record 01 042
CF4 245 Record 01 042
CF4A 246-247 Record 01 043
CG1 250 Record 01 043
CG1A 251-252 Record 01 043
CG13CT 253-254 Record 01 044
CG14CT 258-259 Record 01 044
CG15CT 263-264 Record 01 045
CG16CT 266-267 Record 01 045
CG2 255 Record 01 044
INDEX OF VARIABLES PAGE 005
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CG2A 256-257 Record 01 044
CG3 260 Record 01 044
CG3A 261-262 Record 01 045
CG4 265 Record 01 045
CHOMHLTH (268-271) Record 01 045
CHSEHOLD (055-129) Record 01 004
CH1 268 Record 01 046
CH18CT 270-271 Record 01 046
CH2 269 Record 01 046
CINSCOVR (130-219) Record 01 018
CINTOBS (480-491) Record 01 076
CIPSTAYS (220-224) Record 01 039
CITYPE 014 Record 01 001
CI1 272 Record 01 046
CI2 275 Record 01 047
CI20CT 273-274 Record 01 047
CI21CT 276-277 Record 01 047
CI22CT 279-280 Record 01 047
CI23CT 282-283 Record 01 048
CI24CT 285-286 Record 01 048
CI25CT 288-289 Record 01 049
CI26CT 291-292 Record 01 049
CI3 278 Record 01 047
CI4 281 Record 01 048
CI5 284 Record 01 048
CI6 287 Record 01 048
CI7 290 Record 01 049
CJ1 293 Record 01 049
CJ1A 294-295 Record 01 050
CJ28CT 296-297 Record 01 050
CK1 298 Record 01 050
CK2 299 Record 01 050
CK3 300 Record 01 051
CK30CT 301-302 Record 01 051
CK31CT 304-305 Record 01 051
CK4 303 Record 01 051
CK5 (306-377) Record 01 051
CK5A 306-308 Record 01 052
CK5B 309-311 Record 01 052
CK5C 312-314 Record 01 052
CK5D 315-317 Record 01 052
CK5E 318-320 Record 01 053
CK5F 321-323 Record 01 053
CK5G 324-326 Record 01 053
CK5H 327-329 Record 01 053
INDEX OF VARIABLES PAGE 006
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CK5I 330-332 Record 01 054
CK5J 333-335 Record 01 054
CK5K 336-338 Record 01 054
CK5L 339-341 Record 01 054
CK5M 342-344 Record 01 055
CK5N 345-347 Record 01 055
CK5O 348-350 Record 01 055
CK5P 351-353 Record 01 055
CK5Q 354-356 Record 01 056
CK5R 357-359 Record 01 056
CK5S 360-362 Record 01 056
CK5T 363-365 Record 01 056
CK5U 366-368 Record 01 057
CK5V 369-371 Record 01 057
CK5W 372-374 Record 01 057
CK5X 375-377 Record 01 057
CK6 378-383 Record 01 058
CLBOX1 385 Record 01 058
CLBOX2 386 Record 01 059
CLBOX3 446 Record 01 070
CLBOX4 455 Record 01 072
CL1 384 Record 01 058
CL10 406 Record 01 062
CL11 407-408 Record 01 062
CL12 409 Record 01 062
CL13 (410-413) Record 01 063
CL13MO 410-411 Record 01 063
CL13YR 412-413 Record 01 063
CL14 414 Record 01 063
CL15 415-416 Record 01 064
CL16 417-419 Record 01 064
CL17L18 420-423 Record 01 064
CL18A 424 Record 01 065
CL19 425 Record 01 065
CL2 387-389 Record 01 059
CL20 426 Record 01 065
CL21 427-428 Record 01 066
CL22 429 Record 01 066
CL23 430-431 Record 01 066
CL24 432 Record 01 067
CL25 (433-436) Record 01 067
CL25MO 433-434 Record 01 067
CL25YR 435-436 Record 01 067
CL26 437 Record 01 068
CL27 438-439 Record 01 068
INDEX OF VARIABLES PAGE 007
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CL28 440 Record 01 068
CL29 441 Record 01 069
CL3L4 390-393 Record 01 059
CL30 442-443 Record 01 069
CL31 444-445 Record 01 070
CL32 447 Record 01 070
CL33 (448-452) Record 01 070
CL33BX 452 Record 01 071
CL33DT (448-451) Record 01 071
CL33MO 448-449 Record 01 071
CL33YR 450-451 Record 01 071
CL34 453 Record 01 072
CL35 454 Record 01 072
CL36 456 Record 01 072
CL37 (457-461) Record 01 073
CL37BX 461 Record 01 073
CL37DT (457-460) Record 01 073
CL37MO 457-458 Record 01 073
CL37YR 459-460 Record 01 073
CL38 462 Record 01 074
CL39 (463-467) Record 01 074
CL39BX 467 Record 01 075
CL39DT (463-466) Record 01 074
CL39MO 463-464 Record 01 074
CL39YR 465-466 Record 01 074
CL4A 394 Record 01 060
CL40 468 Record 01 075
CL41 (469-472) Record 01 075
CL41MO 469-470 Record 01 075
CL41YR 471-472 Record 01 075
CL42 473 Record 01 076
CL43 474-479 Record 01 076
CL5 395 Record 01 060
CL6 396-397 Record 01 060
CL7 398-400 Record 01 061
CL8L9 401-404 Record 01 061
CL9A 405 Record 01 061
CMEDVIST (230-249) Record 01 040
CNURSHOM (225-229) Record 01 039
CN1 480 Record 01 076
CN2 481-482 Record 01 077
CN3 483 Record 01 077
CN4 484-485 Record 01 077
CN5 (486-491) Record 01 077
CN5A 486 Record 01 077
INDEX OF VARIABLES PAGE 008
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== C =====
CN5B 487 Record 01 078
CN5C 488 Record 01 078
CN5D 489 Record 01 078
CN5E 490 Record 01 078
CN5F 491 Record 01 079
COTHPROV (250-267) Record 01 043
CPID01 001-009 Record 01 001
CREC01 010-011 Record 01 001
CREFDT (017-022) Record 01 001
CREFDY 019-020 Record 01 002
CREFMO 017-018 Record 01 001
CREFYR 021-022 Record 01 002
CRTYPE 015 Record 01 001
CSREC01 012-013 Record 01 001
===== E =====
ERVS3 043-045 Record 01 003
===== G =====
GAP3FLAG 034 Record 01 003
===== H =====
HCVS3 046-048 Record 01 003
===== I =====
IOANG 016 Record 01 001
IPNGT3 037-039 Record 01 003
===== M =====
MDVS3 052-054 Record 01 004
===== O =====
OBSDAYS3 031-033 Record 01 002
OCVS3 049-051 Record 01 003
===== P =====
PERSON1 (057-062) Record 01 004
PERSON10 (111-116) Record 01 013
INDEX OF VARIABLES PAGE 009
Variable Name Column Numbers Record Number Codebook Page No.
------------- -------------- ------------- -----------------
===== P =====
PERSON2 (063-068) Record 01 005
PERSON3 (069-074) Record 01 006
PERSON4 (075-080) Record 01 007
PERSON5 (081-086) Record 01 008
PERSON6 (087-092) Record 01 009
PERSON7 (093-098) Record 01 010
PERSON8 (099-104) Record 01 011
PERSON9 (105-110) Record 01 012
===== T =====
T3_STAT 029-030 Record 01 002