PATIENT RESPONSE RECORD (continued) Data Field Element XML Element Attributes Description Valid Values Data Type Size Required Q43 None In the last 12 months, how Never 1 Alphanumeric 1 Yes satisfied-problems often were you satisfied with Sometimes 2 character Each element must have a closing tag that the way they handled these Usually 3 is the same as the opening tag but with a problems? 4 forward slash. This patient response data NOT APPLICABLE X element should only occur once per MISSING/DK M patient. Example: Q44 None Medicare and your State have Yes 1 Alphanumeric 1 Yes make-complaint special agencies that check the No 2 character Each element must have a closing tag that quality of care at this dialysis NOT APPLICABLE X is the same as the opening tag but with a center. In the last 12 months, MISSING/DK M forward slash. This patient response data did you make a complaint to element should only occur once per any of these agencies? patient. Example: Q45 None In general, how would you Excellent 1 Alphanumeric 1 Yes overall-health rate your overall health? Very good 2 character Each element must have a closing tag that Good 3 is the same as the opening tag but with a Fair 4 forward slash. This patient response data Poor 5 element should only occur once per MISSING/DK M patient. Example: overall-health1/overall-health
PATIENT RESPONSE RECORD (continued) XML Element Attributes Description Valid Values Data Type Field Size Data Element Required Q43 satisfied-problems 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 In the last 12 months, how often were you satisfied with the way they handled these problems? Never 1 Sometimes 2 Usually 3 4 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q44 make-complaint 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 Medicare and your State have special agencies that check the quality of care at this dialysis center. In the last 12 months, did you make a complaint to any of these agencies? Yes 1 No 2 NOT APPLICABLE X MISSING/DK M Alphanumeric character 1 Yes Q45 overall-health 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: overall-health1/overall-health None In general, how would you rate your overall health? Excellent 1 Very good 2 Good 3 Fair 4 Poor 5 MISSING/DK M Alphanumeric character 1 Yes
ICH_SurveyAdminManual_Ver4_Feb2016.docx