RIC         1  2  $RIC                                  C Record Identification Code

                                   0                    A Administrative Data
                                   0                   DU Dental Events
                                   0                   FA Facility Events
                                   0                    H HMO Supplement
                                   0                   IA Income and Assets
                                   0                   IP Inpatient Hospital Events
                                   0                   IU Institutional Events
                                   0                    K Key Record
                                   0                   KN Knowledge and Information Needs
                                   0                   MD MDS
                                   0                   MP Medical Provider Events
                                   0                    N Non-Respondent
                                   0                   OA OASIS
                                   0                   OP Outpatient Events
                                   0                   PA Patient Activation
                                   0                   PM Prescribed Medicine Events
                                   0                   PS Person Summary
                                   0                   RX Drug Coverage
                                   0                   SS Service Summary
                                   0                    X Cross Sectional Weights
                                   0                   XE Ever Enrolled Weights
                                   0                   X2 2 year Weights
                                   0                   X3 3 year Weights
                                   0                   X4 4 year Weights
                                   0                    1 Survey Identification (Demographic)
                                   0                   10 MDS/OAS Timeline
                                   0                    2 Health Status/Functioning (Community)
                                   0                   2F Health Status/Functioning (Facility)
                                   0                   2H Health Status/Functioning (Helper)
                                   0                   2P Health Status/Functioning (Prevention)
                                   0                    3 Access to Care
                                   0                    4 Health Insurance
                                   0                    5 Enumeration
                                   0                    6 Facility Residence History
                                   0                    7 Facility Characteristics
                                   0                   7S SNF Characteristics
                              29,421                    8 Interview Description
                                   0                    9 Residence Timeline

VERSION     3  1  $VERSION                              C Version Number

                              29,421                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              29,421             LOW-HIGH BASEID Count

INTERVU    12  1  $INTRFMT                              C Type of interview

                              27,848                    C Community
                               1,573                    F Facility

INT_DATE   13  8                                        C Interview Date (YYYYMMDD)

LENGTH     21  5  LENFMT                                N Duration of interview in minutes

                              29,421                      Minutes

LANG       26  2  $LANGFMT           CL26               C Language of interview

                               1,573                   -1 Inapplicable
                              26,662                    E English
                               1,175                    S Spanish
                                  11                   91 Other

                  Note: Applies only to Community interviews

PROXY      28  2  PROXFMT            IN4                N Self - respondent or proxy

                               1,573                    . Missing
                              24,472                    1 SP responded
                               3,376                    2 Proxy responded

                  Note: Applies only to Community interviews

D_PROXRL   30  2  RELFMT             IN4a               N Proxy's relationship to SP

                               1,573                    . Inapplicable
                                   1                   -8 Don't know
                                   0                   -5 Never ask again
                              24,472                    1 Sample person
                               1,093                    2 Spouse
                                 256                    3 Son
                                 796                    4 Daughter
                                  35                    5 Brother
                                 147                    6 Sister
                                  85                    7 Father
                                 410                    8 Mother
                                  14                    9 Son-in-law
                                  85                   10 Daughter-in-law
                                  26                   11 Grandson
                                  42                   12 Granddaughter
                                  19                   13 Nephew
                                  44                   14 Niece
                                  24                   50 Partner/roommate
                                  56                   51 Friend/neighbor
                                   0                   52 Boarder
                                  13                   53 Nurse/nurses aide
                                   6                   54 Legal/financial officer
                                  32                   55 Guardian
                                  50                   91 Other relative
                                 142                   92 Other non-relative

                  Note: Applies only to Community interviews

PNSPNAM    32  2  IND1FMT            IN6a               N Proxy necessary - SP not able mentally

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                               1,389                    1 Indicated
                               1,982                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

PNSPINH    34  2  IND1FMT            IN6a               N Proxy necessary - SP in hospital

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                                  34                    1 Indicated
                               3,337                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

PNSPLAN    36  2  IND1FMT            IN6a               N Proxy necessary - language problem

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                                 266                    1 Indicated
                               3,105                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

PNSPDED    38  2  IND1FMT            IN6a               N Proxy necessary - SP deceased

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                                 284                    1 Indicated
                               3,087                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

PNSPINS    40  2  IND1FMT            IN6a               N Proxy necessary - SP institutionalized

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                                 137                    1 Indicated
                               3,234                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

PNSPUNA    42  2  IND1FMT            IN6a               N Proxy necessary - SP unavailable

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                                 335                    1 Indicated
                               3,036                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

PNSPOTH    44  2  IND1FMT            IN6a               N Proxy necessary - other reason

                              26,045                    . Inapplicable
                                   2                   -9 Not ascertained
                                   3                   -8 Don't know
                                  20                    1 Indicated
                               3,351                    2 Not indicated

                  Note: Applies only to Community interviews with proxies

RRECHELP   46  2  YES1FMT            IR3                N Did respondent receive help answering?

                               2,195                    . Inapplicable
                               4,136                    1 Yes
                              23,090                    2 No

                  Note: Optional interviewer data applicable to community interviews

D_IHLPRL   48  2  RELFMT             IR3                N Helper's relationship to SP

                              25,285                    . Inapplicable
                                   1                   -9 Not ascertained
                                   0                   -5 Never ask again
                                   7                    1 Sample person
                               2,787                    2 Spouse
                                 184                    3 Son
                                 442                    4 Daughter
                                  13                    5 Brother
                                  64                    6 Sister
                                  46                    7 Father
                                 124                    8 Mother
                                  21                    9 Son-in-law
                                  49                   10 Daughter-in-law
                                  11                   11 Grandson
                                  29                   12 Granddaughter
                                   9                   13 Nephew
                                  25                   14 Niece
                                  82                   50 Partner/roommate
                                  88                   51 Friend/neighbor
                                   1                   52 Boarder
                                  28                   53 Nurse/nurses aide
                                   2                   54 Legal/financial officer
                                   3                   55 Guardian
                                  24                   91 Other relative
                                  96                   92 Other non-relative

                  Note: Applies only if RRECHELP = 1

RINFOSAT   50  2  YES1FMT            IR5                N Info provided by respondent satisfactory

                               2,195                    . Inapplicable
                              26,963                    1 Yes
                                 263                    2 No

                  Note: Optional interviewer data applicable to community interviews

SEQNUM     52  3                                        N Sequence number within SP

TOTLINTV   55  3                                        N Total interviews for SP

FACILID    58  6  $FACLFMT                              C Facility ID

                              27,848                      Missing
                               1,573                      Facility ID

                  Note: Randomly-assigned number

