This study investigated the costs of chronic pain in adolescents (aged between 11 and 18). The CSRI was specifically adapted for this study, and was completed by 52 families. The abstract for the paper can be found here, and the CSRI can be downloaded here.
The sections related to hospital service receipt are quite extensive compared to CSRIs used in studies involving different population groups (for example, people with dementia).
We can also see that in question 7 respondents can answer yes OR no to the receipt of each service. This can be helpful in identifying missing values in the dataset that would be compiled from answers to these questionnaires. If the respondent does not have an opportunity to specifically state that they did not use a service researchers would have to judge whether the blank data entry they end up with means that they did not use the service or if this data is missing.
This CSRI also does not ask for data related to the receipt of benefits. In some instances this data is not used and therefore does not need to be collected. One example of this is if a societal perspective is adopted: benefits are payment transfers and therefore would not be considered a cost.