Section EW [ECONOMIC WELL-BEING) Sequence: 35

Size: px
Start display at page:

Download "Section EW [ECONOMIC WELL-BEING) Sequence: 35"

Transcription

1 NHATS Round Section EW [ECOMIC WELL-BEING) Sequence: 5 EW ewpycredbal R EW PAY OFF CREDIT CARD BALAN If PROXY flag is null, or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "Do you". Otherwise display "Does SP". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". If HP = (HAVE TRADITIONAL MORTGAGE) or HP = (HAVE REVERSE MORTGAGE), display "other kinds of". These next questions are about {other kinds of} debt. {Do you/does SP} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} usually pay off all credit card balances every month or only the minimum amount due? PAY OFF BALANCE PAY MINIMUM PAY MORE THAN MINIMUM, BUT T ENTIRE BALANCE DON T HAVE ANY CREDIT CARDS EW ewcrecardeb R EW TOTAL CREDIT CARD DEBT SHOW CARD EW Adding up all credit card balances, is the amount owed less than $,000, $,000 - $,999, $,000 - $,999, $,000 - $5,999, $6,000 - $9,999, $0,000 - $9,999, or $0,000 or more? EW ewcredcdmed R EW CREDIT CARD MEDICAL CARE Is any of the amount owed on credit cards for medical care? Page of 9

2 EW ewamtcrdmed R EW AMT ON CARDS FOR MED CARE How much is for medical care? Would you say most, some, or a little of the amount owed? MOST SOME A LITTLE ewmedpaovtm R MED BILLS PAID OVERTIME If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "Do you". Otherwise, display "Does SP". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Display "paid off over time" in underlined text. {Do you/does SP} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} have any medical bills that are being paid off over time? EW7 EW7 EW7 EW6 ewampadovrt R EW6 AMT FOR MED BIL OVR TIME SHOW CARD EW About how much is that amount? Is it.. less than $500, $500 - $999, $,000 - $,999, Page of 9

3 $,000 - $,999, $,000 - $5,999, $6,000 - $9,999, $0,000 - $9,999, or $0,000 or more? EW7 ewfinhlpfam R EW7 FINANCIAL HELP FRM FAMILY If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "you". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". If any PERSON ROSTER members have relationship codes = (DAUGHTER), (SON), 7 (STEPDAUGHTER), or 8 (STEPSON), display "children or other". Family members often help each other out financially. The next questions are about last year, ending December, {CURRENT YEAR - YEAR}. Last year, did {you/sp} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} receive any financial help or financial gifts from {children or other} relatives, either regularly -- like every month -- or just every so often as needed? EW EW EW BOX EW8 BOX EW8 T ON FILE If any PERSON ROSTER members have relationship codes = (DAUGHTER), (SON), 7 (STEPDAUGHTER), or 8 (STEPSON), go to EW8. Otherwise, go to EW0. EW8 ewwhohelfi ewwhohelfi R EW8 CHILD HELPED FINANCIALLY R EW8 OTHER HELPED FINANCIALLY If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "your". Otherwise, display "SP's". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display "or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME/LASTNAME}'s". If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Page of 9

4 Was that one of {your/sp's} {or {SP FIRSTNAME/LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}'s} children or someone else who helped out (financially)? SELECT ALL THAT APPLY CHILD/CHILDREN SOMEONE ELSE EW0 EW0 EW0 Allow code all that apply EW9 opchhlpfin R E9 CHILDREN WHO HELP FINANCE Display PERSON ROSTER members with relationship codes = (DAUGHTER), = (SON), 7 (STEPDAUGHTER), or 8 (STEPSON) with FIRST NAME, LAST NAME, and RELATIONSHIP TO SP. Which children helped out (financially)? ENTER TEXT PROBE: Any other children? SELECT ALL THAT APPLY Allow code all that apply. For each roster selection at EW9, set HELPEDSPFINANCIALLY flag = () to person roster. EW0 ewatchhelyr R EW0 AMT FROM CHILDR LST YR SHOW CARD EW About how much was that in the last year (ending December, {CURRENT YEAR YEAR}}? Would you say less than $500, $500 - $999, $,000 - $,999, $,000 - $,999, $,000 - $5,999, $6,000 - $9,999, $0,000 - $9,999, or $0,000 or more? Page of 9

5 EW ewfingftfam R EW FINANCIAL GIFTS TO FAMILY If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "you". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER)], display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Otherwise display "SPOUSE/PARTNER FIRSTNAME LASTNAME". If any PERSON ROSTER members have relationship codes = (DAUGHTER), (SON), 7 (STEPDAUGHTER), or 8 (STEPSON), display "children or other". Last year, ending December, {CURRENT YEAR - YEAR}, did {you/sp} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} give any financial help or financial gifts to {children or other} relatives, either regularly -- like every month -- or just every so often as needed? BOX EW BOX E T ON FILE If any PERSON ROSTER members have relationship codes = (DAUGHTER), (SON), 7 (STEPDAUGHTER), or 8 (STEPSON), go to EW. Otherwise, go to EW. EW ewwhregoth ewwhregoth ewwhregoth R EW GAVE CHILD FINCL HLP R EW SP GAVE GRANDCHD FIN HLP R EW SP GAVE OTHR FINANCL HLP If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "your". Otherwise, display "SP's". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display "or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}'S". If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Was that (financial) help to one of {your/sp's} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}'s} children, a grandchild, or someone else? SELECT ALL THAT APPLY CHILD/CHILDREN GRANDCHILD/GRANDCHILDREN SOMEONE ELSE EW EW EW Page 5 of 9

6 EW Allow code all that apply EW ophlpchfin R EW HELPED CHILDREN FINANCE Display PERSON ROSTER members with relationship codes = (DAUGHTER), = (SON), 7 (STEPDAUGHTER), or 8 (STEPSON) with FIRST NAME, LAST NAME, and RELATIONSHIP TO SP. Which children were helped (financially)? ENTER TEXT PROBE: Any other children? SELECT ALL THAT APPLY Allow code all that apply For each roster selection at EW, set SPHELPEDFINANCIALLY flag = () to person roster. EW ewamthlpgiv R EW AMOUNT OF HELP GIVEN SHOW CARD EW About how much was that in the last? Would you say less than $500, $500 - $999, $,000 - $,999, $,000 - $,999, $,000 - $5,999, $6,000 - $9,999, $0,000 - $9,999, or $0,000 or more? BOX BOX E5 T ON FILE Go to. ewprogneed ewprogneed ewprogneed R SP RECEIVD FOOD STAMPS R SP REC OTHR FOOD ASST R SP REC GAS ENERGY ASST Page 6 of 9

7 If PROXY flag is null, or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "you". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Use "Same Question Stem" display. If at a, do not display question text in brackets. Otherwise, display question text in brackets. Display "in the last year" in bold underlined text. {[} There are several state and federal programs that help people in need. In the last year, did {you/sp} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} receive help from any of these programs? {]} RESPONSE [] a. Food stamps (also called the Supplemental Nutrition Assistance Program, or SNAP)? RESPONSE [] b. Other food assistance such as Meals-on-Wheels? RESPONSE [] c. Gas, electricity, or other energy assistance? Array the responses and variable text columns in the panel. Display "variable text" in the a-c sequence until all rows have been displayed. EW6 ewmealskip R EW6 SKIP MEALS MONEY If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "you". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Display "last month" in underlined text. We know people sometimes find it hard to make ends meet. Thinking about the last month, did {you/sp} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} skip any meals because there was not enough food, or money to buy food? EW8 EW8 EW8 Page 7 of 9

8 EW7 ewmealskip R EW7 SKIP MEALS HOW OFTEN If PROXY flag is null or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "you". If CURRENT INT SP MARITAL STATUS from PERSON ROSTER = (MARRIED) or (LIVING WITH A PARTNER), display If PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "SP FIRSTNAME LASTNAME". Display "last month" in underlined text. How many days in the last month did {you/sp} {or {SP FIRSTNAME LASTNAME/SPOUSE/PARTNER FIRSTNAME LASTNAME}} skip meals? Would you say nearly every day, more than half the days, several days, but less than half the days, or a few days? NEARLY EVERY DAY MORE THAN HALF THE DAYS SEVERAL DAYS (LESS THAN HALF) A FEW DAYS EW8 ewnopayhous ewnopayutil ewnopaymed R EW8A MONEY FOR HOUSING R EW8B MONEY FOR UTILITIES R EW8C MONEY FOR MEDICAL Use "Same Question Stem" display. Display last year in underlined text. If at EW8a, do not display question text in brackets. Otherwise, display question text in brackets. {[}Were there times in the last year when {you/sp} did not have enough money to {]} RESPONSE [] a. pay the rent or mortgage? RESPONSE [] b. pay utility bills (gas, electric)? RESPONSE [] c. pay medical or prescription drug bills Array the responses and variable text columns in the panel. Display "variable text" in the a-c sequence until all rows have been displayed. Go to Section HL Helpers. Page 8 of 9

9 Page 9 of 9

Section EW [ECONOMIC WELL-BEING) Sequence: 40

Section EW [ECONOMIC WELL-BEING) Sequence: 40 NHATS Round 5 Section EW [ECOMIC WELL-BEING) Sequence: 0 EW ew5pycredbal R5 EW PAY OFF CREDIT CARD BALAN If PROXY flag is null, or PROXY RELATIONSHIP = (SPOUSE/PARTNER), display "Do you". Otherwise display

More information

Section EW [ECONOMIC WELL-BEING] Sequence: 42

Section EW [ECONOMIC WELL-BEING] Sequence: 42 NHATS Round 1 Section EW [ECONOMIC WELL-BEING] Sequence: 42 EW1 ew1pycredbal R1 EW1 PAY OFF CREDIT CARD BALAN If PROXY flag is null, or PROXY RELATIONSHIP = 2 (SPOUSE/PARTNER), display "Do you". Otherwise

More information

National Study of Caregiving

National Study of Caregiving National Study of Caregiving Section HC [HEALTH CARE INTERACTIONS] Sequence: 5 HCPRE HCPRE T ON FILE If SP DECEASED flag = () and ((SP MONTH OF DEATH or SP YEAR OF DEATH) = RF or DK), display of {SP} s

More information

National Study of Caregiving

National Study of Caregiving National Study of Caregiving Section CA [CARE ACTIVITIES] Sequence: CAPRE CAPRE T ON FILE Display date as Month, day, year with month spelled out. First we have a few questions about ways you may have

More information

Section FQ [FACILITY STAFF QUESTIONNAIRE] Sequence: 48 TO SELECT ANOTHER CASE, BREAKOFF AND SELECT THE CORRECT CASE ID FROM THE IMS

Section FQ [FACILITY STAFF QUESTIONNAIRE] Sequence: 48 TO SELECT ANOTHER CASE, BREAKOFF AND SELECT THE CORRECT CASE ID FROM THE IMS NHATS Round 1 Section FQ [FACILITY STAFF QUESTIONNAIRE] Sequence: 48 FQ1PRE FQ1PRE NOT ON FILE QUESTION TEXT YOU HAVE SELECTED THE FACILITY STAFF QUESTIONNAIRE (FQ) FOR CASE {CASE ID}, {SP} IF THIS IS

More information

Section FQ [FACILITY STAFF QUESTIONNAIRE] Sequence: 48 TO SELECT ANOTHER CASE, BREAKOFF AND SELECT THE CORRECT CASE ID FROM THE IMS

Section FQ [FACILITY STAFF QUESTIONNAIRE] Sequence: 48 TO SELECT ANOTHER CASE, BREAKOFF AND SELECT THE CORRECT CASE ID FROM THE IMS NHATS Round Section FQ [FACILITY STAFF QUESTIONNAIRE] Sequence: 48 FQPRE FQPRE QUESTION TEXT YOU HAVE SELECTED THE FACILITY STAFF QUESTIONNAIRE (FQ) FOR CASE {CASE ID}, {SP} IF THIS IS CORRECT, PRESS AND

More information

HRS SECTION A: COVERSCREEN FINAL VERSION -- 8/15/2016 ************************************************************

HRS SECTION A: COVERSCREEN FINAL VERSION -- 8/15/2016 ************************************************************ HRS 2016 -- SECTION A: COVERSCREEN FINAL VERSION -- 8/15/2016 ************************************************************ NOTE ABOUT BRANCHPOINTS: WHERE THERE IS MORE THAN ONE JUMP WITHIN A BRANCHPOINT

More information

Individual Support Grant Application Form

Individual Support Grant Application Form Individual Support Grant Application Form The MS Society provides grants to people with MS for items needed as a direct result of their MS, for which there is no health or social services funding available.

More information

701C CONGREGATE MEALS ASSESSMENT

701C CONGREGATE MEALS ASSESSMENT 701C CONGREGATE MEALS ASSESSMENT Rick Scott, Governor Charles T. Corley, Secretary An Overview of the 2013 701C Changes Introduction - 701C The 701C is intended to be administered for congregate meal clients.

More information

Household survey on access and use of medicines

Household survey on access and use of medicines Household survey on access and use of medicines A training guide to field work Purpose of this training Provide background on the WHO household survey on access and use of medicines Train on data gathering

More information

CPOM TRAINING. Page 1

CPOM TRAINING. Page 1 CPOM TRAINING Page 1 Physician Training For CPOM Patient list columns, Flag Management, Icons Icons added for CPOM: Columns added: Flags New Orders: GREEN - are general orders. RED means STAT orders included

More information

Application for FY nd Round Privately Funded Scholarships

Application for FY nd Round Privately Funded Scholarships Student ID Number Name (in Chinese character) Nationality Bachelor Master Doctor Grade period : from Application for FY 2018 2nd Round Privately Funded Scholarships destination / country : to 302 from

More information

Health Care Proxy Appointing Your Health Care Agent in New York State

Health Care Proxy Appointing Your Health Care Agent in New York State Health Care Proxy Appointing Your Health Care Agent in New York State The New York Health Care Proxy Law allows you to appoint someone you trust for example, a family member or close friend to make health

More information

HCAHPS. Telephone Script (English) Effective January 1, 2018 Discharges and Forward

HCAHPS. Telephone Script (English) Effective January 1, 2018 Discharges and Forward HCAHPS Telephone Script (English) Effective January 1, 2018 Discharges and Forward Overview This telephone interview script is provided to assist interviewers while attempting to reach the patient. The

More information

What is included in my Campus Recreation membership? I am a UAlbany graduate student. Do I need to purchase a membership?

What is included in my Campus Recreation membership? I am a UAlbany graduate student. Do I need to purchase a membership? Membership What is included in my Campus Recreation membership? If you are a community member or UAlbany affiliate (Alumni, Spouse/Partner of a faculty/staff member, or UAlbany retiree) your Campus Recreation

More information

Social Determinants of Health Webinar

Social Determinants of Health Webinar PART: Preventing Avoidable Readmissions Together Social Determinants of Health Webinar Neal Axon MD Ana Defede PhD Melanie Matney PART: Preventing Avoidable Readmissions Together To provide an overview

More information

2017 Holiday Programs FAQ

2017 Holiday Programs FAQ 2017 Holiday Programs FAQ HELP s holiday programs provide holiday assistance to those who are unemployed, on a fixed income and the working poor who, without our programs, would otherwise go without. Your

More information

A guide to housing options available through local authorities Easy to Read Version

A guide to housing options available through local authorities Easy to Read Version Housing Options A guide to housing options available through local authorities Easy to Read Version www.rebuildingireland.ie www.housing.ie What is in this document? 1. What is social housing support?

More information

HCAHPS. Active Interactive Voice Response Script (English) Effective January 1, 2018 Discharges and Forward

HCAHPS. Active Interactive Voice Response Script (English) Effective January 1, 2018 Discharges and Forward HCAHPS Active Interactive Voice Response Script (English) Effective January 1, 2018 Discharges and Forward Overview This active interactive voice response (IVR) interview script is provided to assist operators

More information

OKDHS Pub. No A Issued 4/2011

OKDHS Pub. No A Issued 4/2011 OKDHS Pub. No. 11-20A Issued 4/2011 This publication is authorized by the Oklahoma Commission for Human Services in accordance with state and federal regulations and printed by the Oklahoma Department

More information

Expense Guide to Saving Tax

Expense Guide to Saving Tax Expense Guide to Saving Tax FOR THE SELF EMPLOYED Hey guys, We get you. You re a one person business. You love what you do and you decided to make a living out of it. It s not an easy world out there.

More information

Medicaid May Pay for Nursing Home Care

Medicaid May Pay for Nursing Home Care If you re 60 or over, call your local legal aid office: Eastern CT 800-413-7796 Western CT 800-413-7797 Hartford Area 860-541-5000 Bridgeport Area 800-809-4434 Stamford Area 800-541-8909 New Haven Area

More information

Deciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health

Deciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health Deciding About Health Care A GUIDE FOR PATIENTS AND FAMILIES New York State Department of Health 2 Introduction Who should read this guide? This guide is for New York State patients and for those who will

More information

APPENDIX O: XML DATA FILE LAYOUT FOR DISPROPORTIONATE STRATIFIED RANDOM SAMPLING

APPENDIX O: XML DATA FILE LAYOUT FOR DISPROPORTIONATE STRATIFIED RANDOM SAMPLING APPENDIX O: XML DATA FILE LAYOUT FOR DISPROPORTIONATE STRATIFIED RANDOM SAMPLING Centers for Medicare & Medicaid Services Appendix O: XML File Layout for Disproportionate Stratified Random Sampling January

More information

Sample 1: Over Income

Sample 1: Over Income EAP Denial Letters This document illustrates EAP denial letters. These letters are sent from central mailing and distribution and are triggered from batches generated in eheat. Following are examples for

More information

APPLICATION FOR BURGLAR ALARM LICENSE (IN ACCORDANCE WITH G.S. 74D) [Type or Print in Black Ink] 1. Name First Middle (Maiden) Last (Nickname)

APPLICATION FOR BURGLAR ALARM LICENSE (IN ACCORDANCE WITH G.S. 74D) [Type or Print in Black Ink] 1. Name First Middle (Maiden) Last (Nickname) NORTH CAROLINA ALARM SYSTEMS LICENSING BOARD 3101 Industrial Drive Suite 104 Raleigh, North Carolina 27609 Phone: (919) 788-5320 Fax: (919) 788-5365 E-Mail: PPSASL@ncdps.gov www.ncdps.gov/asl.aspx APPLICATION

More information

Gender And Caregiving Network Differences In Adult Child Caregiving Patterns: Associations With Care-Recipients Physical And Mental Health

Gender And Caregiving Network Differences In Adult Child Caregiving Patterns: Associations With Care-Recipients Physical And Mental Health Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Public Health Theses School of Public Health January 2015 Gender And Caregiving Network Differences In Adult Child Caregiving

More information

LIHEAP and Weatherization Application and Required Documentation Check List

LIHEAP and Weatherization Application and Required Documentation Check List Application and Required Documentation Check List Energy Intake Form CSD43: Completed, signed and dated in blue or black ink. Do not use white out. GNS Application: Completed in blue or black ink. Information

More information

Need food stamp verification letter georgia

Need food stamp verification letter georgia Search Search pages & people Search Search Search pages & people Search Need food stamp verification letter georgia The Georgia Senior SNAP program is an elderly simplified application project. You may

More information

How to Read a Medicare Summary Notice (MSN)

How to Read a Medicare Summary Notice (MSN) The Medicare Summary Notice (MSN) is a report of doctor visits, services, or supplies billed to Medicare in your name. It is mailed every three months when Medicare has been billed for services and is

More information

CATHERINE FUND FINANCIAL AID APPLICATION March 2016

CATHERINE FUND FINANCIAL AID APPLICATION March 2016 GUIDELINES/ QUALIFICATIONS FOR Please read all Guidelines, Policies and Procedures, and Instructions before completing application. You must meet all guidelines for your application to be considered. 1.

More information

CESR-SCHAEFFER WORKING PAPER SERIES

CESR-SCHAEFFER WORKING PAPER SERIES Harmonization of Cross-National Studies of Aging to the Health and Retirement Study - User Guide: Family Transfer - Informal Care Urvashi Jain, Joohong Min, Jinkook Lee Paper No: 2016-008 CESR-SCHAEFFER

More information

How to Coordinate a Scout Outing for Troop 94

How to Coordinate a Scout Outing for Troop 94 Latest Revision: 01 January 2014 How to Coordinate a Scout Outing for Troop 94 Objective: To guide an adult volunteer in the proper procedures, communications, cost analysis, and paperwork required for

More information

Demographic and Health Surveys Methodology

Demographic and Health Surveys Methodology Out-of-pocket Health expenditures module Questionnaire and interviewer s manual Demographic and Health Surveys Methodology This document is part of the Demographic and Health Survey s DHS Toolkit of methodology

More information

A2. [IF PARENT SURVEY] What is your relationship to [CLIENT S NAME]? Are you his/her [READ EACH]

A2. [IF PARENT SURVEY] What is your relationship to [CLIENT S NAME]? Are you his/her [READ EACH] A. CLIENT CHARACTERISTICS A1. Would you prefer to conduct this interview in English or in French? 1 English 2 French A2. [IF PARENT SURVEY] What is your relationship to [CLIENT S NAME]? Are you his/her

More information

Go! Guide: Adding Medication Administration History

Go! Guide: Adding Medication Administration History Go! Guide: Adding Medication Administration History Introduction Past medication administrations are often an integral part of a patient scenario. It may be important for students to review the patient

More information

PROVIDENCE MOUNT ST. VINCENT Hand In Hand Assisted Living Apartments Residency Application/Pre-Admission Assessment I.

PROVIDENCE MOUNT ST. VINCENT Hand In Hand Assisted Living Apartments Residency Application/Pre-Admission Assessment I. PROVIDENCE MOUNT ST. VINCENT Hand In Hand Assisted Living Apartments Residency Application/Pre-Admission Assessment I. BASIC INFORMATION Name First Middle Last What you prefer to be called: DOB: Age: Today

More information

Ruth & Norman Rales Jewish Family Services Center for Families & Children 2018 Camp Scholarship Application- Application Date:

Ruth & Norman Rales Jewish Family Services Center for Families & Children 2018 Camp Scholarship Application- Application Date: Ruth & Norman Rales Jewish Family Services Center for Families & Children 2018 Camp Scholarship Application- Application Date: Print name (First Mother): Middle): (Last): _ Age: Did you apply Last Year

More information

APPLICATION FOR STUDY ABROAD AND EXCHANGE

APPLICATION FOR STUDY ABROAD AND EXCHANGE APPLICATION FOR STUDY ABROAD AND EXCHANGE Please scan and email, fax or post this form and all attachments to Study Abroad Coordinator Deakin University Melbourne Burwood Campus, Building C1.15 221 Burwood

More information

Guide to the 1983 Mental Health Act For nearest relatives of detained service users

Guide to the 1983 Mental Health Act For nearest relatives of detained service users South London and Maudsley NHS Foundation Trust Guide to the 1983 Mental Health Act For nearest relatives of detained service users Introduction This booklet is for anyone who is the nearest relative for

More information

Go! Guide: Medication Administration

Go! Guide: Medication Administration Go! Guide: Medication Administration Introduction Medication administration is one of the most important aspects of safe patient care. The EHR assists health care professionals with safety by providing

More information

MANITOBA GOVERNMENT INVENTORY OF PERSONAL INFORMATION SYSTEMS WORKSHEET. Here are a few important pointers to help you fill out the Worksheet:

MANITOBA GOVERNMENT INVENTORY OF PERSONAL INFORMATION SYSTEMS WORKSHEET. Here are a few important pointers to help you fill out the Worksheet: MANITOBA GOVERNMENT INVENTORY OF PERSONAL INFORMATION SYSTEMS WORKSHEET Here are a few important pointers to help you fill out the Worksheet: Read the Inventory Instructions. Print copies of this Worksheet.

More information

Long Term Care in Alberta Residential Facilities GOVERNMENT-SUBSIDIZED NURSING HOMES. How Nursing Homes are Organized and Administered

Long Term Care in Alberta Residential Facilities GOVERNMENT-SUBSIDIZED NURSING HOMES. How Nursing Homes are Organized and Administered Long Term Care in Alberta 2016 Residential Facilities GOVERNMENT-SUBSIDIZED NURSING HOMES How Nursing Homes are Organized and Administered Nursing homes in Alberta provide room and board and a range of

More information

AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM

AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM KIMBERLY K. DELP, RN BSN January 26, 2017 AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM 1

More information

Respite (short breaks)

Respite (short breaks) www.patientclientcouncil.hscni.net Respite (short breaks) This report is about what people with a learning disability and their families told us about respite in Northern Ireland August 2011 Your voice

More information

MODULE ELEVEN. Getting Credit for the Work You Do: Entering Units of Service

MODULE ELEVEN. Getting Credit for the Work You Do: Entering Units of Service MODULE ELEVE Getting Credit for the Work ou Do: Entering Units of Service 1 2 Policy In order to effectively evaluate and remain competitive for funding, all service providers and medical case managers

More information

NEW PATIENT QUESTIONNAIRE

NEW PATIENT QUESTIONNAIRE NEW PATIENT QUESTIONNAIRE Plympton Medical Practice Ivybridge Medical Practice Chaddlewood Medical Practice Wotter Medical Practice The information that we are seeking on this form is to help us offer

More information

Stop, if you are under the age of 21 and living with your parents, an office visit is required.

Stop, if you are under the age of 21 and living with your parents, an office visit is required. TIME SAVING TIPS! IMPORTANT INFORMATION FOR MEDI-CAL APPLICANTS ONLY APPLYING FOR MEDI-CAL? MAIL IN YOUR APPLICATION AND SAVE TIME! Stop, if you are under the age of 21 and living with your parents, an

More information

Appendix B: Topline Results

Appendix B: Topline Results Appendix B: Topline Results From a National Survey of Caregivers 18 and Older for National Alliance for Caregiving & AARP January 2003 Interviewing conducted September 5 through December 22, 2003, among

More information

Oklahoma Health Care Authority. ECHO Adult Behavioral Health Survey For SoonerCare Choice

Oklahoma Health Care Authority. ECHO Adult Behavioral Health Survey For SoonerCare Choice Oklahoma Health Care Authority ECHO Adult Behavioral Health Survey For SoonerCare Choice Executive Summary and Technical Specifications Report for Report Submitted June 2009 Submitted by: APS Healthcare

More information

Acute. Proposing Surgical Procedure Orders and Orders. Surgical Procedure Orders and Orders Affiliated. Requesting a Surgical Encounter FIN#:

Acute. Proposing Surgical Procedure Orders and Orders. Surgical Procedure Orders and Orders Affiliated. Requesting a Surgical Encounter FIN#: Acute Surgical Procedure Orders and Orders Affiliated Proposing Surgical Procedure Orders and Orders Requesting a Surgical Encounter FIN#: 1. Office calls Pre-registration at 801-387-7646 or 800-624-3972.

More information

Frequently Asked Questions

Frequently Asked Questions Frequently Asked Questions General Questions... 2 What is DOS Grants?... 2 How do I navigate the site?... 2 Accounts and Profiles... 2 How do I create an account?... 2 Why does it say I already have an

More information

This supplemental material has been supplied by the author and has not been edited by Annals of Family Medicine.

This supplemental material has been supplied by the author and has not been edited by Annals of Family Medicine. Supplemental materials for: Hudon C, Chouinard M, Diadiou F, Lambert M, Bouliane D. Case management in primary care for frequent users of health care services with chronic diseases: a qualitative study

More information

OUTPATIENT ASSESSMENT SMMC: Page 1 of 5 Adopted Date: Revised Date: 10/02; 6/04; 11/04 Reviewed Date: Name Birthdate Phone Number:

OUTPATIENT ASSESSMENT SMMC: Page 1 of 5 Adopted Date: Revised Date: 10/02; 6/04; 11/04 Reviewed Date: Name Birthdate Phone Number: Name Birthdate Phone Number: Dear Patient and Family, Please answer the following questions. Your answers will help your health care team plan and give care to you or your significant other. A nurse will

More information

Home is Best Ltd Housing Support Service 20 Ballewan Crescent Blanefield Glasgow G63 9HW

Home is Best Ltd Housing Support Service 20 Ballewan Crescent Blanefield Glasgow G63 9HW Home is Best Ltd Housing Support Service 20 Ballewan Crescent Blanefield Glasgow G63 9HW Type of inspection: Unannounced Inspection completed on: 29 July 2014 Contents Page No Summary 3 1 About the service

More information

Sample eheat Letters. Request for Information Letter Request for Information (with Authorized Representative)

Sample eheat Letters. Request for Information Letter Request for Information (with Authorized Representative) Sample eheat Letters This document provides examples of some of the EAP letters generated through eheat. Following are the examples included in this document: Request for Information Letter Request for

More information

Speare Memorial Hospital myspeare Patient Portal User Guide

Speare Memorial Hospital myspeare Patient Portal User Guide Speare Memorial Hospital myspeare Patient Portal User Guide pg. 1 myspeare Patient Portal User Guide Table of Contents Topic Page # Homepage..3 Proxy Access. 4 Contact Us.. 5 What s New.. 6 Profile...7

More information

NEW BRUNSWICK HOME CARE SURVEY

NEW BRUNSWICK HOME CARE SURVEY NEW BRUNSWICK HOME CARE SURVEY MARKING INSTRUCTIONS: Please fill in or place a check in the circle that best describes your experiences with home care services. If you wish, a caregiver, friend, or family

More information

Point of Care: Medication Pass with Pre-Pour

Point of Care: Medication Pass with Pre-Pour Point of Care: Medication Pass with Pre-Pour This manual covers completion of a Medication Pass with Pre-Pour in Point of Care. Click the Pre-Pour icon on the Point of Care home screen. Enter the time

More information

Q1 How important is home care availability?

Q1 How important is home care availability? Q1 How important is home care availability? Very important Important Somewhat unimportant t important at all Very important Important Somewhat unimportant t important at all 85.65% 776 12.80% 116 1.43%

More information

Primary care patient experience survey April 2016

Primary care patient experience survey April 2016 Primary care patient experience survey April 2016 Survey overview 1. This version of the survey does not show the logic that skips people to appropriate questions based on their answers. Not all people

More information

Caring for the Caregiver. Module #9 1

Caring for the Caregiver. Module #9 1 Caring for the Caregiver Module #9 1 Learning objectives The purpose of this seminar: Understand the impact of the caregiver role on physical and psychological health Identify techniques for caregiver

More information

Center for Clinical Standards and Quality/Survey & Certification Group

Center for Clinical Standards and Quality/Survey & Certification Group DEPARTMENT OF HEALTH & HUMAN SERVICES 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 Center for Clinical Standards and Quality/Survey & Certification Group July 10, 2014 Linda

More information

Family Structure and Nursing Home Entry Risk: Are Daughters Really Better?

Family Structure and Nursing Home Entry Risk: Are Daughters Really Better? Family Structure and Nursing Home Entry Risk: Are Daughters Really Better? February 2001 Kerwin Kofi Charles University of Michigan Purvi Sevak University of Michigan Abstract This paper assesses whether,

More information

Patient and Family Caregiver Interview Tool

Patient and Family Caregiver Interview Tool Patient and Family Caregiver Interview Tool Instructions: We recommend you select at least 5-10 patients who have been readmitted to your organization within the past 30 days to include in the group of

More information

American Institute in Taiwan

American Institute in Taiwan American Institute in Taiwan Vacancy Announcement Number: 2018-01 OPEN TO: POSITION: OPENING DATE: All Interested Candidates Mechanical/BAS Engineer January 10, 2018 (re-open) CLOSING DATE: January 31,

More information

Appendix B. Survey Items

Appendix B. Survey Items Appendix B Survey Items Ten items were presented to respondents assessing their perceptions of interference between work and non-work life. Items were developed by Netemeyer, Boles, and McMurrian (1996).

More information

Additional Support Services

Additional Support Services Additional Support Services The following services are not directly offered by ElderSource. However, our Customer Service Specialists will be pleased to talk with you, assess your specific needs and connect

More information

Do you need help paying your energy bills?

Do you need help paying your energy bills? Long Island gas customers Do you need help paying your energy bills? This is an important notice. Please have it translated. Questa è un informazione importante, si prega di tradurla. Sometimes circumstances

More information

Table 1. Summary of works on the Caregivers Reaction Assessment instrument

Table 1. Summary of works on the Caregivers Reaction Assessment instrument Table 1. Summary of works on the Caregivers Reaction Assessment instrument Study Sample size Care-receiver Caregiver Mean age (yrs) Female (%) Spouse (%) Anal. Model Factor structures Given, et al., 1992

More information

Indiana Energy Assistance Program Application Part 1. Personal Information

Indiana Energy Assistance Program Application Part 1. Personal Information INSERT AGENCY LOGO 2017-2018 Indiana Energy Assistance Program Application Part 1. Personal Information Your Name Date of Birth First MI Last Social Security Number MM-DD-YYYY Current Home Address: Street

More information

FAFSA & Application Update

FAFSA & Application Update Virginia W Hagins Training Officer U.S. Department of Education WASFAA Conference 2013 Phoenix, AZ FAFSA & Application Update Agenda 2013-2014 FAFSA Enhancements CPS Processing and ISIR Changes Verification

More information

Fordingbridge. Hearts At Home Care Limited. Overall rating for this service. Inspection report. Ratings. Requires Improvement

Fordingbridge. Hearts At Home Care Limited. Overall rating for this service. Inspection report. Ratings. Requires Improvement Hearts At Home Care Limited Fordingbridge Inspection report 54 Avon Meade Fordingbridge Hampshire SP6 1QR Tel: 01425657329 Website: www.heartsathomecare.co.uk Date of inspection visit: 25 July 2017 26

More information

APPLICATION FOR FUNDING LOCAL RECIPIENT ORGANIZATION EMERGENCY FOOD AND SHELTER NATIONAL PROGRAM PHASE 35 ORANGE COUNTY, NEW YORK, JURISDICTION #6228

APPLICATION FOR FUNDING LOCAL RECIPIENT ORGANIZATION EMERGENCY FOOD AND SHELTER NATIONAL PROGRAM PHASE 35 ORANGE COUNTY, NEW YORK, JURISDICTION #6228 APPLICATION FOR FUNDING LOCAL RECIPIENT ORGANIZATION EMERGENCY FOOD AND SHELTER NATIONAL PROGRAM PHASE 35 ORANGE COUNTY, NEW YORK, JURISDICTION #6228 Key Dates Activity Request for Application Released

More information

Rotary Club of Milwaukee 2015 Scholarship Application

Rotary Club of Milwaukee 2015 Scholarship Application Rotary Club of Milwaukee Scholarships are awarded to Milwaukee Area students during their senior year of High School or during college. Applications are to be submitted to the RCM scholarship committee

More information

Conducting a Community Needs Assessment

Conducting a Community Needs Assessment Conducting a Community Needs Assessment Benefits of Conducting a Community Needs Assessment: In order to determine whether the ministries of a parish are satisfying a need in the community, it is important

More information

Self-Directed Support

Self-Directed Support Self-Directed Support Disabled Facilities Grants - DFGs Just because someone is disabled doesn t mean they have to leave their own home. Many people make changes and adaptations. Some might pay for the

More information

2015 Request for Applications Qatar Foundation International QFI EDUCATION AWARDS HIGH SCHOOL DEADLINE TO APPLY: APRIL 30, 2015

2015 Request for Applications Qatar Foundation International QFI EDUCATION AWARDS HIGH SCHOOL DEADLINE TO APPLY: APRIL 30, 2015 2015 Request for Applications Qatar Foundation International QFI EDUCATION AWARDS HIGH SCHOOL DEADLINE TO APPLY: APRIL 30, 2015 Summary Qatar Foundation International (QFI), LLC, is a U.S.-based member

More information

VERIFICATION IRS DRT AND TAX TRANSCRIPTS. Verification Resources. Verification Resources. NDASFAA 2012 Verification 04/12/2012

VERIFICATION IRS DRT AND TAX TRANSCRIPTS. Verification Resources. Verification Resources. NDASFAA 2012 Verification 04/12/2012 VERIFICATION IRS DRT AND TAX TRANSCRIPTS NDASFAA Spring 2012 Ft. Yates, North Dakota April 12, 2012 Verification Resources 6/18/10 NPRM (Pages 34825 34834) http://www.ifap.ed.gov/fregisters/fr061810programi

More information

LAGRANGE COUNTY COMMUNITY FOUNDATION SCHOLARSHIP APPLICATION (2017)

LAGRANGE COUNTY COMMUNITY FOUNDATION SCHOLARSHIP APPLICATION (2017) Last four digits of Social Security Number LAGRANGE COUNTY COMMUNITY FOUNDATION SCHOLARSHIP APPLICATION (2017) SECTION 1 BACKGROUND: LYLE SMITH SCHOLARSHIP Mr. Lyle Smith attended Westview School and currently

More information

Troop Leadership Positions

Troop Leadership Positions Troop Leadership Positions Senior Patrol Leader (SPL) The Senior Patrol Leader is elected by the Scouts to represent them as the top junior leader in the troop. Preside at all troop meetings, events, activities,

More information

Pressure Perfect Monitoring System. Marilyne Mendolla Vidhya Pillai

Pressure Perfect Monitoring System. Marilyne Mendolla Vidhya Pillai Pressure Perfect Monitoring System Marilyne Mendolla Vidhya Pillai Abstract In an attempt to bring commercial blood pressure monitors up to speed with current technology, we wish to design a monitoring

More information

New Student Leader Handbook

New Student Leader Handbook New Student Leader Handbook Being a new student leader can be overwhelming at first. Below is a list of a few things you need to start thinking about to help your club run smoothly throughout the year.

More information

Angela Max Maxwell. Dear Prospective Volunteers and Interns,

Angela Max Maxwell. Dear Prospective Volunteers and Interns, Dear Prospective Volunteers and Interns, Thank you for your interest in The Bunny Hutch Boutique and CLIMATES-Rescue. Our volunteers and interns are a precious resource. Interns and Volunteers contribute

More information

Clinical Procedures For Medical Assistants By Kathy Bonewit-West READ ONLINE

Clinical Procedures For Medical Assistants By Kathy Bonewit-West READ ONLINE Clinical Procedures For Medical Assistants By Kathy Bonewit-West READ ONLINE If you are looking for a book Clinical Procedures for Medical Assistants by Kathy Bonewit-West in pdf format, then you've come

More information

The Holyoke Medical Center (HMC) Patient Portal User Guide

The Holyoke Medical Center (HMC) Patient Portal User Guide The Holyoke Medical Center (HMC) Patient Portal User Guide 1 HMC Patient Portal User Guide Table of Contents Topic Page # Homepage...3 Proxy Access...4 Contact Us...5 What s New....5-6 Profile...7 Appointments...8-10

More information

2018 C.A.R.E Study. Financial and Lifestyle Costs of Caregiving. The Northwestern Mutual Life Insurance Company Milwaukee, WI

2018 C.A.R.E Study. Financial and Lifestyle Costs of Caregiving. The Northwestern Mutual Life Insurance Company Milwaukee, WI The Northwestern Mutual Life Insurance Company Milwaukee, WI 2018 C.A.R.E Study Financial and Lifestyle Costs of Caregiving Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance

More information

Hansel Day Services Support Service Without Care at Home Hansel Alliance, Hansel Village Broad Meadows Symington Kilmarnock KA1 5PU Telephone: 01563

Hansel Day Services Support Service Without Care at Home Hansel Alliance, Hansel Village Broad Meadows Symington Kilmarnock KA1 5PU Telephone: 01563 Hansel Day Services Support Service Without Care at Home Hansel Alliance, Hansel Village Broad Meadows Symington Kilmarnock KA1 5PU Telephone: 01563 831470 Inspected by: Sean McGeechan Michael Thomson

More information

Caregiving in the U.S.: Spotlight on Virginia

Caregiving in the U.S.: Spotlight on Virginia Caregiving in the U.S.: Spotlight on Virginia Published April 2004 Caregiving in the U.S.: Spotlight on Virginia Data Collected by Belden Russonello & Stewart Report Prepared by Belden Russonello & Stewart

More information

Family Investment Administration ACTION TRANSMITTAL

Family Investment Administration ACTION TRANSMITTAL Department of Human Resources 311 West Saratoga Street Baltimore MD 21201 Family Investment Administration ACTION TRANSMITTAL Control Number: # 10-36 Effective Date: July 1, 2010 Issuance Date: June 11,

More information

LAGRANGE COUNTY COMMUNITY FOUNDATION SCHOLARSHIP APPLICATION (2017)

LAGRANGE COUNTY COMMUNITY FOUNDATION SCHOLARSHIP APPLICATION (2017) Last four digits of Social Security Number LAGRANGE COUNTY COMMUNITY FOUNDATION SCHOLARSHIP APPLICATION (2017) SECTION 1 OLIVE B. COLE FOUNDATION SCHOLARSHIP BACKGROUND: Since the early 1960s, the Olive

More information

This publication is available digitally on the AFDPO WWW site at:

This publication is available digitally on the AFDPO WWW site at: BY ORDER OF THE SECRETARY OF THE AIR FORCE AIR FORCE INSTRUCTION 34-241 1 NOVEMBER 1997 COMPLIANCE WITH THIS PUBLICATION IS MANDATORY 62D AIRLIFT WING Supplement 1 13 DECEMBER 2001 Services MEAL CARD PROGRAM

More information

Total Health Assessment Questionnaire for Medicare Members

Total Health Assessment Questionnaire for Medicare Members Total Health Assessment Questionnaire for Medicare Members Please answer the following questions about your health and day-to-day activities. This questionnaire usually takes around 10-15 minutes to complete.

More information

Fall Quality Improvement Group: Program Acceptance. Background

Fall Quality Improvement Group: Program Acceptance. Background Background Fall 2014 Quality Improvement Group: Program Acceptance Every Healthy Families team member is valuable. The specific role of the FAW in the HFF model is a unique position that carries great

More information

Jake Olson, PharmD 9/28/2016. Improving Patient Care Through Improved Pharmacist-Prescriber Relationships. President/CEO, Skywalk Pharmacy

Jake Olson, PharmD 9/28/2016. Improving Patient Care Through Improved Pharmacist-Prescriber Relationships. President/CEO, Skywalk Pharmacy Improving Patient Care Through Improved Pharmacist-Prescriber Relationships Sponsored by Merck Jake Olson, PharmD Hamid Abbaspour, RPh, MBA Amanda Faber, PharmD, MBA Briana P. Murray, PharmD Jake Olson,

More information

Abstracts previously presented at other national or international meetings will be accepted.

Abstracts previously presented at other national or international meetings will be accepted. Abstract Submission Deadline: February 28, 2017 Notification: no later than March 17, 2017 Second Annual Thursday, April 27-Saturday, April 29, 2017 Hilton, Columbus Downtown go.osu.edu/brainhealth The

More information

43. Special Treatment Programs

43. Special Treatment Programs Medi-Cal Handbook page 43-1 43. 43.1 General The Medi-Cal (MSTP) provide health care benefits to persons who are in need of: Dialysis, or Parenteral hyperalimentation (also known as total parenteral nutrition

More information

Your Right to Make Health Care Decisions

Your Right to Make Health Care Decisions 42 P O Box 10600 Grand Junction, CO 81502-5600 Your Right to Make Health Care Decisions Advance Directives What is an Advance Directive? It is a type of written instruction about your health care to be

More information

FAIR WORK COMMISSION INCREASES MINIMUM AWARD RATES OF PAY & ALLOWANCES

FAIR WORK COMMISSION INCREASES MINIMUM AWARD RATES OF PAY & ALLOWANCES VICTORIA, TASMANIA, NSW, ACT & QLD FAIR WORK COMMISSION INCREASES MINIMUM AWARD RATES OF PAY & ALLOWANCES ELECTRICAL, ELECTRONIC & COMMUNICATIONS CONTRACTING AWARD 2010 s and allowances contained in this

More information

Family Inpatient Communication Survey. Instructions and Instrument

Family Inpatient Communication Survey. Instructions and Instrument Family Inpatient Communication Survey Instructions and Instrument Purpose: The FICS is a measure of perceived communication by family members of incapacitated patients in the inpatient hospital setting.

More information