PATIENT RESPONSE RECORD <final-status> Note: A Survey results record is required if the final is Mail Phone “110-Completed survey,” “120-Completed survey,” Mail survey, Eligibility Not Currently Receiving Does not meet “130-Completed unknown,” “140-Ineligible: Dialysis,” “160-Ineligible: eligibility No longer receiving care at sample Proxy Completed or criteria,” “190-Ineligible: facility,” “199-Ineligible: Survey,” Survey results records are not required for a valid data submission but if survey results are included then there must be an entry for every survey item in the ICH CAHPS Survey. Data Field Element XML Element Attributes Description Valid Values Data Type Size Required Q1 None Where do you get your At home 1 Alphanumeric 1 Yes where-dialysis dialysis treatments? At the dialysis character Each element must have a closing tag that center 2 is the same as the opening tag but with a Not currently forward slash. This patient response data receiving dialysis 3 element should only occur once per MISSING/DK M patient. Example: Q2 None How long have you been Less than 3 months 1 Alphanumeric 1 Yes how-long-care getting dialysis at [SAMPLE At least 3 months character Each element must have a closing tag that FACILITY NAME]? but less than 1 year 2 is the same as the opening tag but with a At least 1 year but forward slash. This patient response data less than 5 years 3 element should only occur once per 5 years or more 4 patient. No longer at this Example: center 5 NOT APPLICABLE X MISSING/DK M
PATIENT RESPONSE RECORD Note: A Survey results record is required if the final <final-status> is “110-Completed Mail survey,” “120-Completed Phone survey,” “130-Completed Mail survey, Eligibility unknown,” “140-Ineligible: Not Currently Receiving Dialysis,” “160-Ineligible: Does not meet eligibility criteria,” “190-Ineligible: No longer receiving care at sample facility,” “199-Ineligible: Proxy Completed Survey,” or Survey results records are not required for a valid data submission but if survey results are included then there must be an entry for every survey item in the ICH CAHPS Survey. XML Element Attributes Description Valid Values Data Type Field Size Data Element Required Q1 where-dialysis Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None Where do you get your dialysis treatments? At home 1 At the dialysis center 2 Not currently receiving dialysis 3 MISSING/DK M Alphanumeric character 1 Yes Q2 how-long-care Each element must have a closing tag that is the same as the opening tag but with a forward slash. This patient response data element should only occur once per patient. Example: None How long have you been getting dialysis at [SAMPLE FACILITY NAME]? Less than 3 months 1 At least 3 months but less than 1 year 2 At least 1 year but less than 5 years 3 5 years or more 4 No longer at this center 5 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes