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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Health Insurance Questionnaire

812 Shared Subjects

N/A
Clinical Assessments
Questionnaire
01/22/2015
insur01
02/15/2024
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project id
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query days_baseline Integer Recommended Days since baseline dayinsur, hcdays
Query assbdic String 5 Recommended Assessment Point D;14;E;24;LB;36;72;96;120; 9; B; 3; 7; 144; 168;192; C D=MTA baseline assessment; 14=MTA 14 month assessment; E=MTA early termination assessment; B = MTA Pre-Baseline Screening Assessment (579/579); 09 = MTA 9 Month Assessment (530/530); 24=MTA 24 month assessment; LB=LNCG baseline assessment; 36=MTA and LNCG 3 year assessment; 72=MTA and LNCG 6 year assessment; 96=MTA and LNCG 8 year assessment; 03 = MTA 3 Month Assessment (438/687);120=MTA and LNCG 10 year assessment; 7= 7th Grade Assessment (221/276); 144 = MTA & LNCG 12 Month Assessment (578/578); 168 = MTA & LNCG 14 Month Assessment (585/585); 192 = MTA & LNCG 16 Month Assessment (505/505); C = MTA Pre-Baseline Screening Assessment (78/78) assinsur
Query relationship Integer Recommended Relationship of respondent to individual
1::94;-999
1 = Biological mom; 2 = Biological dad; 3 = Grandparent; 4 = Special education (sped) teacher; 5 = General education teacher; 6 = Occupational therapist; 7 = Speech and language therapist; 8 = Behavioral therapist; 9 = Paraprofessional; 10 = Aide; 11 = Principal; 12 = Administrator; 14 = Content teacher; 15 = Parent center director; 16 = Self; 17=Adoptive mother; 18=Adoptive father; 19=Foster mother; 20 = Foster father; 21=Grandmother; 22=Grandfather; 23=Step-mother; 24 = Step-father; 25=Aunt; 26=Uncle; 28=Both parents;31= Grandmother from mother side; 32= Grandfather from mother side; 33= Grandmother from father side; 34= Grandfather from father side; 36= Brother; 37= Sister; 38= Cousin; 39= female caregiver; 40=male caregiver; 41=Female child; 42=Male child; 43=Spouse/Mate; 44=Friend; 45=Parent; 46=Significant other; 47=Sibling; 48=Son/Daughter; 49=Son-in-law/Daughter-in law; 50=Other Relative; 51=Paid caregiver; 52=Friends; 53=Roommate; 54=Supervisor; 55=mother's boyfriend; 56=other parental figure; 57=Summary; 58=counselor ; 59 = other female relative; 60 = other male relative; 61 = non-relative ; 62=Maternal Aunt; 63=Maternal Uncle; 64=Maternal Cousin; 65 = Paternal Aunt; 66=Paternal Uncle; 67=Paternal Cousin ; 68=Biological/Adoptive Mother and Grandmother; 69=Biological/Adoptive Mother and Stepmother and Grandmother; 70=Biological/Adoptive Mother and Grandmother and Foster Father; 71=Biological/Adoptive Mother and Stepmother and Foster Mother; 72=Biological/Adoptive Mother and Foster Mother; 73=Biological/Adoptive Mother and Biological/Adoptive Father; 74=Biological/Adoptive Mother and Stepmother and Biological/Adoptive Father; 75=Biological/Adoptive Mother and Other; 76=Biological/Adoptive Mother and Stepmother and Stepfather; 77=Biological/Adoptive Mother and Stepfather; 78=Biological/Adoptive Mother and Grandfather; 79=Biological/Adoptive Mother and Stepmother and Foster Father; 80=Biological/Adoptive Mother and Stepmother; 81=Guardian, female; 82=Other female; 83=Guardian, male; 84=Other male; 85=Other/Grandparent/Nanny; 86 = Mother, Father, Guardian; 87 = Daughter, son, grandchild; 88 = Professional (e.g., social worker, nurse, therapist, psychiatrist, or group home staff); -999=Missing; 89 = Biological parent; 90=Other; 91 = Stepparent; 92 = Adoptive parent; 93 = Foster parent; 94 = Co-worker relinsur
Query actbdic Integer Recommended Active status 0::5 0=Inactive-Data collected after the 14 month treatment phase/after early termination from treatment phase/prior to treatment phase; 1=Active-Data collected during the 14 month treatment phase while subject received originally assigned treatment regardless of degree of compliance; 2=Active-This is the last active assessment for subjects who were about to violate treatment arm by receiving alternate treatment; 3=Active-This is the last active assessment for subjects who were about to leave the study by moving away;4=Yes, Active; 5=No, Not Active actinsur
Query site String 101 Recommended Site Study Site sitenum
Query sjtyp Integer Recommended Subject type 1;2 1=MTA randomized trial subject; 2=Local normative comparison group (LNCG) subject
Query insur1a Integer Recommended 1st Health insurance coverage this adolescent has TODAY 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur1b Integer Recommended 2nd Health insurance coverage this adolescent has TODAY 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur1c Integer Recommended 3rd Health insurance coverage this adolescent has TODAY 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur1d Integer Recommended 4th Health insurance coverage this adolescent has TODAY 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur3a Integer Recommended 1st Health insurance coverage this adolescent had 2 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur3b Integer Recommended 2nd Health insurance coverage this adolescent had 2 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur3c Integer Recommended 3rd Health insurance coverage this adolescent had 2 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur3d Integer Recommended 4th Health insurance coverage this adolescent had 2 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur4a Integer Recommended 1st Health insurance coverage this adolescent had 3 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur4b Integer Recommended 2nd Health insurance coverage this adolescent had 3 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur4c Integer Recommended 3rd Health insurance coverage this adolescent had 3 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur4d Integer Recommended 4th Health insurance coverage this adolescent had 3 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur5a Integer Recommended 1st Health insurance coverage this adolescent had 4 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur5b Integer Recommended 2nd Health insurance coverage this adolescent had 4 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur5c Integer Recommended 3rd Health insurance coverage this adolescent had 4 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur5d Integer Recommended 4th Health insurance coverage this adolescent had 4 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur6a Integer Recommended 1st Health insurance coverage this adolescent had 5 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur6b Integer Recommended 2nd Health insurance coverage this adolescent had 5 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur6c Integer Recommended 3rd Health insurance coverage this adolescent had 5 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur6d Integer Recommended 4th Health insurance coverage this adolescent had 5 YEARS ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other
Query insur7 Integer Recommended TODAY, my adolescent has the following coverage. 1::4 1=Adolescents physician is selected by the health plan; 2=Adolescents physician must be chosen from a list provided by the health plan; 3=Adolescents physician may be chosen from a list provided by the health plan - if I choose a different physician I must pay more; 4=Health plan does not provide a list - health plan pays the same no matter which provider adolescent sees
Query insur8 Integer Recommended TODAY, my adolescents health plan pays the following for prescriptions 1::4 1=None; 2=All costs above a certain amount; 3=Percent of total prescriptions per year; 4=Dollar total for prescriptions per year
Query insur8g Float Recommended If INSUR8=2, the $____per generic prescription
Query insur8bd Float Recommended If INSUR8=2, the $____per brand name (if annual deductible, amount: $___).
Query insur8pp Float Recommended If INSUR8=3, the _____% of the prescription cost
Query insur8pd Float Recommended If INSUR8=3, the annual deductible, amount: $____.
Query insur8py Float Recommended If INSUR8=4, the $____ total for prescriptions per year
Query insur9 Integer Recommended TODAY, my adolescents health plan limits the number of visits to a specialty mental health provider (e.g., psychiatrist, psychologist, other therapist, or counselor) to: 1::4 1=No limit; 2=Do not know of a limit; 3=Definite limit or limit of paid visits; 4=Know there is a limit but don�t know what it is
Query insur9v Integer Recommended If INSUR9=3, the ____ visits
Query insur9l Float Recommended If INSUR9=3, the $_____ limit that are paid for
Query insur10 Integer Recommended In the past 1 YEAR, did your adolescent see a specialty mental health provider (e.g., psychiatrist, psychologist, other therapist, or counselor)? 1;2 1=No; 2=Yes
Query insur11 Integer Recommended Did you pay anything out-of-pocket for the LAST visit to a specialty mental health provider? 1;2 1=No; 2=Yes
Query insur11p Float Recommended If INSUR11=2, $_____ (this is the amount the insurance does not pay).
Query insur12 Integer Recommended In the past 1 YEAR, did your adolescent see a regular doctor (e.g., family doctor or pediatrician) for Attention Deficit Hyperactivity Disorder (ADD, ADHD, hyperactivity, attention difficulties, etc.)? 1;2 1=No; 2=Yes
Query insur13 Integer Recommended Did you pay anything out-of-pocket for the LAST visit to a regular doctor for ADHD? 1;2 1=No; 2=Yes
Query insur13p Float Recommended If INSUR13=2, $_____ (this is the amount the insurance does not pay).
Query insur2aa Integer Recommended 1st Health insurance coverage this adolescent had 1 YEAR ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other insur2a
Query insur2ba Integer Recommended 2nd Health insurance coverage this adolescent had 1 YEAR ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other insur2b
Query insur2ca Integer Recommended 3rd Health insurance coverage this adolescent had 1 YEAR ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other insur2c
Query insur2da Integer Recommended 4th Health insurance coverage this adolescent had 1 YEAR ago 1::7 1=No insurance; 2=Employer coverage; 3=Individual coverage; 4=Medicaid/Medi-Cal; 5=State plan; 6=Canadian Medicare; 7=Other insur2d
Query chartreview016b Integer Recommended Does the Patient have insurance? 0;1;9; -888; -999 0=No; 1=Yes; 9=Not documented; -888=Not Applicable; -999=Missing; hc_1
Query chartreview016c_1 Integer Recommended What type of insurance does the patient have? Private Health Insurance 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_7
Query chartreview016c_10 Integer Recommended What type of insurance does the patient have? Medicare 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_3
Query chartreview016c_2 Integer Recommended What type of insurance does the patient have? Medi-Gap 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_6
Query chartreview016c_3 Integer Recommended What type of insurance does the patient have? Medicaid 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_9
Query chartreview016c_4 Integer Recommended What type of insurance does the patient have? SCHIP (CHIP/Childrens Health Insurance Program) 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_10
Query chartreview016c_5 Integer Recommended What type of insurance does the patient have? Military Health Care (Tricare/VA/CHAMP-VA) 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_11
Query chartreview016c_7 Integer Recommended What type of insurance does the patient have? State-sponsored health plan 0;1; -888;-999 0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing; hc_12
Query hc_2 Integer Recommended So, you are uninsured, is that correct 0;1 0=No; 1=Yes
Query hc_4 Integer Recommended Are you enrolled in Part B of Medicare which provides coverage for doctor and clinic visits laboratories and other nonhospital services 0;1 0=No; 1=Yes
Query hc_5 Integer Recommended Are you enrolled in Part D of Medicare which provides coverage for prescription medications 0;1 0=No; 1=Yes
Query hc_8 Integer Recommended Does this plan pay for some part of your prescription medications? 0;1 0=No; 1=Yes
Query hc_13 Integer Recommended Does this plan pay for some part of your prescription medications 0;1 0=No; 1=Yes
Query hc_14 Integer Recommended Do you receive medications or get help in paying for medications from any other programs 0;1 0=No; 1=Yes
Query hc_15 Integer Recommended You get free or subsidized health care services directly from any other program 0;1 0=No; 1=Yes
Query hc_16 Integer Recommended Does this program also provide prescription medications 0;1 0=No; 1=Yes
Query hc_17 Integer Recommended In the past have you ever had health insurance 0;1 0=No; 1=Yes
Query hc_18 Integer Recommended When did you become uninsured? 1::5 1 = Within the past six months;2 = Within the past year3 = Within the past 2 years;4 = Within the past 5 years;5 = More than 5 years ago
Query visit String 60 Recommended Visit name timept
Query hc_7a Integer Recommended Are you covered by any private health insurance plan (excluding Medigap plans) such as health insurance that you obtain through an employer or through COBRA or through a family member or buy personally 0::4 0=No; 1=Yes, employer; 2=Yes, Cobra or bought personally; 3=Yes, through a family member; 4=Yes, some other private source
current_health_insurance Integer Recommended Which of the following best describes your current health insurance situation? 0::10 0 = I have no health insurance.; 1 = I am covered by my parents' insurance.; 2 = I am covered by my husband's or wife's insurance.; 3 = I get insurance through work.; 4 = I get insurance through a union.; 5 = I get insurance through school.; 6 = I am covered because I am active-duty military.; 7 = I buy private insurance myself.; 8 = I am covered by Medicaid (e.g., Medi-Cal).; 9 = I am covered through the Indian Health Service.; 10 = I don't know what my health insurance coverage is.
healthins8_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... State-sponsored health plan 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins9_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Other government program 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins10_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... No coverage of any type 0;1;99 0 = No; 1 = Yes; 99 = No Data
medicalcoverage_1 Integer Recommended COMPUTE MedicalCoverage_1 =SUM(healthins1_1 to healthins9_1). VAR LAB MedicalCoverage_1 'W1: Some type of Medical Coverage'. EXECUTE. 0::9;99 Number of kinds of medical coverage; 99 = No Data
healthins1_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Private health insurance 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins2_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Medicare 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins3_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Medigap 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins4_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Medicaid 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins5_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Children's Health Insurance Program (CHIP) 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins6_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Military related health care 0;1;99 0 = No; 1 = Yes; 99 = No Data
healthins7_1 Integer Recommended We are interested in what kinds of health insurance or health care coverage you may have. Do you have... Indian Health Service 0;1;99 0 = No; 1 = Yes; 99 = No Data
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
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