Form Coding Instructions

This protocol references "two weeks prior to the COVID-19 outbreak". Investigators are encouraged to provide respondents a reference point for the time frame. For most places in the US, this would be mid-March 2020

Source: RTI International

97108-5 Which of the following best describes your work situation in the two weeks prior to the COVID-19 outbreak?

Observation ID in Form

1

Fully-Specified Name

Component
Employment status in the 2W prior to COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Employment status in the 2 weeks prior to COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5882-7

AnswerCodeScoreAnswer ID
Working full timeLA32016-0
Working part timeLA32017-8
Self-employedLA32018-6
Looking for work, unemployedLA32019-4
Unemployed, not lookingLA32020-2
Temporarily laid offLA32021-0
RetiredLA17991-3
HomemakerLA17959-0
Maternity leaveLA32023-6
Illness/sick leaveLA32024-4
DisabledLA17994-7
OtherLA46-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97109-3 Did you start a new job during the COVID-19 outbreak?

Observation ID in Form

1a

Fully-Specified Name

Component
New employment during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

New employment during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97110-1 What setting(s) were you working in the two weeks before the COVID-19 outbreak?

Observation ID in Form

1b

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Work setting in the 2W before the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Work setting in the 2 weeks before the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5883-5

AnswerCodeScoreAnswer ID
At homeLA27446-6
In a medical setting (hospital, clinic, doctor's office, urgent care center, etc.)LA32026-9
In an office or apartment buildingLA32027-7
In a private household(s) (nanny, housekeeper, etc.)LA32028-5
In a setting with regular customer interaction (delivery, transport, retail, food service, restaurant, etc.)LA32029-3
In the community as a first responder (police, EMS, firefighter, etc.)LA32030-1
In a warehouse or factoryLA32032-7
Outside (gardening, construction, road work, etc.)LA32031-9
OtherLA46-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

85658-3 What kind of work did you do?

Term Description

This term is used to report the patient's occupation at a given point in time. To report occupation history, use LOINC 11341-5.

Part Descriptions

LP133724-7   Occupation
The type of work done by the subject during his or her working life. Source: Regenstrief LOINC

Observation ID in Form

1c

Fully-Specified Name

Component
Occupation
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Occupation [Type]

Basic Attributes

Class
ADMIN.PATIENT.DEMOG
Type
Clinical
First Released
Version 2.61
Last Updated
Version 2.66 (MIN)
Order vs. Observation
Both

Example Answer List LL3926-4

Externally Defined
Yes
Code System
CDC-PHIN
Code System OID
1.3.6.1.4.1.12009.10.1.2564
Link to External List
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7186

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]
87825-6National Trauma Data Standard - version 2018 set

Language Variants Get Info

TagLanguageTranslation
el-GRGreek (Greece)Επάγγελμα:Type:Pt:^Ασθενής:Nom:
Synonyms: - ADMIN ADMIN.PATIENT ADMIN.PATIENT.DEMOG Nom Pt Type Ασθενής Επάγγελμα
es-MXSpanish (Mexico)Ocupación:Tipo:Punto temporal:^ Paciente:Nominal:
it-ITItalian (Italy)Occupazione:Tipo:Pt:^Paziente:Nom:
Synonyms: Amministrativo Dati demografici del paziente Paziente Punto nel tempo (episodio)
nl-NLDutch (Netherlands)beroep:type:moment:^patiënt:nominaal:
ru-RURussian (Russian Federation)Род занятости:Тип:ТчкВрм:^Пациент:Ном:
Synonyms: Номинальный;Именной Точка во времени;Момент
zh-CNChinese (China)职业:类型:时间点:^患者:名义型:
Synonyms: 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 型 时刻;随机;随意;瞬间 行业;工作;业务;专业 行政;管理;施行;执行;经营 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员) 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员).人口统计学信息(人口统计学、人口统计、人口统计数据、人口统计学数据、人口统计特征、人口统计学特征、个人基本信息、人员基本信息、个人基本资料、个人基本数据)

97111-9 Did you lose any job(s) during the COVID-19 outbreak?

Observation ID in Form

2

Fully-Specified Name

Component
Job loss during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Job loss during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5884-3

AnswerCodeScoreAnswer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8
Yes, I was laid off from a jobLA32033-5
Yes, I was furloughed from a jobLA32034-3
Yes, I lost all my jobsLA32035-0

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97112-7 Did you continue to work at all during the COVID-19 outbreak?

Observation ID in Form

2a

Fully-Specified Name

Component
Worked during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Worked during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97109-3 Did you start or get [a new/another] job during the COVID-19 outbreak?

Observation ID in Form

2b

Fully-Specified Name

Component
New employment during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

New employment during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97113-5 Did you experience significant changes with your job (e.g. workload, hours, pay, etc.) because of or during the outbreak?

Observation ID in Form

3

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Significant job changes during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Significant job changes during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5885-0

AnswerCodeScoreAnswer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8
Yes, switched to working remotelyLA32036-8
Yes, increase in work hoursLA32037-6
Yes, decrease in work hoursLA32038-4
Yes, increase in workloadLA32039-2
Yes, decrease in workloadLA32040-0
Yes, salary or wages cutLA32041-8
Yes, salary or wages increasedLA32042-6
Yes, other significant change, specifyLA32043-4

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97114-3 What setting(s) have you been working in since the COVID-19 outbreak began?

Observation ID in Form

4

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Work setting during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Work setting during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5883-5

AnswerCodeScoreAnswer ID
At homeLA27446-6
In a medical setting (hospital, clinic, doctor's office, urgent care center, etc.)LA32026-9
In an office or apartment buildingLA32027-7
In a private household(s) (nanny, housekeeper, etc.)LA32028-5
In a setting with regular customer interaction (delivery, transport, retail, food service, restaurant, etc.)LA32029-3
In the community as a first responder (police, EMS, firefighter, etc.)LA32030-1
In a warehouse or factoryLA32032-7
Outside (gardening, construction, road work, etc.)LA32031-9
OtherLA46-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97115-0 In the weeks before COVID-19 outbreak began, were you a student (enrolled in an academic program)?

Observation ID in Form

5

Fully-Specified Name

Component
Student in the few weeks before COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Student in the few weeks before COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5886-8

AnswerCodeScoreAnswer ID
Full time studentLA32044-2
Part time studentLA32045-9
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97116-8 After the COVID-19 outbreak began, did you continue to be a student?

Observation ID in Form

5a

Fully-Specified Name

Component
Student during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Student during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5887-6

AnswerCodeScoreAnswer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8
No, graduated or finished program earlyLA32046-7
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97117-6 Since the COVID-19 outbreak, has your school offered classes remotely?

Observation ID in Form

5b

Fully-Specified Name

Component
School has offered classes remotely during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

School has offered classes remotely during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97118-4 Did you experience an increase or decrease in schoolwork (time spent working)?

Observation ID in Form

5c

Fully-Specified Name

Component
Increase or decrease in schoolwork during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Increase or decrease in schoolwork during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Order vs. Observation
Observation

Normative Answer List LL5888-4

AnswerCodeScoreAnswer ID
IncreaseLA32048-3
DecreaseLA32049-1
No changeLA64-1

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97119-2 [Has it been/Was it] hard to get your [work/schoolwork] done because of other responsibilities at home (taking care of children, family, tension, space)?

Observation ID in Form

6

Fully-Specified Name

Component
Difficulty getting work or schoolwork done because of other responsibilities at home during the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Difficulty getting work or schoolwork done because of other responsibilities at home during the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97120-0 [Has it been/Was it] hard to get your [work/school work] done because of your home environment (internet, computers, tension, space)?

Observation ID in Form

7

Fully-Specified Name

Component
Difficulty getting work or schoolwork done because of your home environment during the COIVD-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Difficulty getting work or schoolwork done because of your home environment during the COIVD-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97121-8 Did anyone in your house lose their job or lose a significant amount of their income as a result of the COVID-19 outbreak?

Observation ID in Form

8

Fully-Specified Name

Component
Household job or income loss due to the COVID-19 outbreak
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Household job or income loss due to the COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]

97122-6 Who lost their job or a significant amount of income as a result of the COVID-19 outbreak?

Observation ID in Form

8a

Fully-Specified Name

Component
Person who lost job or income due to COVID-19 outbreak
Property
Find
Time
Pt
System
^Household member
Scale
Nom
Method

Long Common Name

Household member who lost job or income due to COVID-19 outbreak

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.71 (MIN)
Change Reason
Release 2.71: CLASS: Moved from survey class specific to the instrument to the more encompassing SURVEY.COVID class to gather all COVID-19 related surveys in a single class.;
Order vs. Observation
Observation

Normative Answer List LL5889-2

AnswerCodeScoreAnswer ID
PartnerLA32050-9
ParentsLA32051-7
My childrenLA32052-5
SiblingsLA32053-3
GrandparentsLA16276-0
Other family members (e.g., aunt, uncle, cousin)LA32055-8
Friend(s)LA32056-6
Other household members/roomatesLA32057-4
Other, specifyLA46-8

Member of these Panels

LOINCLong Common Name
97123-4COVID-19 experiences - employment and school changes panel [COVEX]