Generated Narrative: Organization BHAOrganizationExample

identifier: United States National Provider Identifier/1234567893

active: true

type: Provider

name: Community Health Clinic

telecom: ph: (+1) 555-555-5555, hq@chc.example.org

address: 100 Hope Place Denver CO 11111 USA

Generated Narrative: Patient BHAClientExampleNorth

Last updated: 2025-02-18 10:15:00+0000

Profile: BHA Client Profile

Sofia Elena Martinez (official) Female, DoB: 1987-04-22 ( Social Security number)

Marital Status:Never Married
Other Id:State Identifier/1234567892
Contact Detail4500 E Colfax Ave Denver CO 80220 (home)
Language:English (preferred)
us-veteran-statusfalse
US Core Ethnicity Extension:
US Core Birth Sex ExtensionF
US Core Race Extension:

Generated Narrative: EpisodeOfCare BHAEpisodeOfCareExampleNorthSUD

Last updated: 2025-02-18 10:15:00+0000

Profile: BHA EpisodeOfCare Profile

status: Finished

type: Substance Use Disorder

Diagnoses

-ConditionRole
*Substance Use Disorder DiagnosisAdmission diagnosis

patient: Sofia Martinez

managingOrganization: Community Health Clinic

period: 2023-06-01 --> 2025-02-18

Generated Narrative: Condition BHAEpisodeDiagnosisExampleNorthSUD

clinicalStatus: Active

verificationStatus: Confirmed

category: Encounter Diagnosis, Substance Use Disorder

code: SUD Intensive Outpatient (IOP)

subject: Sofia Martinez

Generated Narrative: QuestionnaireResponse BHAAdmissionQuestionnaireResponseExampleNorth

LinkIDTextDefinitionAnswerdoco
.. BHAAdmissionQuestionnaireResponseExampleNorthQuestionnaire:BHA Admission Questionnaire
... lastUpdated2025-02-18T10:15:00Z
... SERVICE_IDENTIFIERService IdentifierBHA Service Identifier Codes: 09 (SUD Intensive Outpatient (IOP))
... FIRST_CONTACT_DATEDate of First Contact2023-06-01
... FIRST_APPOINTMENT_OFFERED_DATEDate of First Appointment Offered2023-06-05
... MEDICATION_ASSISTED_THERAPYMedication Assisted Therapytrue
... REFERRAL_SOURCEReferral SourceBHA Referral Source: 1 (Individual (self, family, friend))
... ARRESTS_PAST_30_DAYSArrests in Past 30 Days1
... EMPLOYMENT_STATUSEmployment StatusBHA Employment Status: 01 (Employed Full Time (35+ hours/week))
... LIVING_SITUATIONLiving SituationBHA Living Situation: 1 (Correctional facility / Jail)
... MONTHLY_INCOMEMonthly Income1200
... PRIMARY_INCOME_SOURCEPrimary Source of income/support for client (or for client's parent if client >18 years of age)BHA Income Source: 2 (Public Assistance)
... PREGNANCY_STATUSPregnancy Statusfalse
... WITHIN_1_YEAR_POSTPARTUM_STATUSWithin 1 Year Postpartum Statusfalse
... SPECIAL_CONNECTIONS_ENROLLMENTEnrollment in Special Connectionsfalse
... ACT_ENROLLMENTEnrollment in ACT?false
... ASCENT_ENROLLMENTEnrollment in Ascent (FEP)?false
... NUMBER_DEPENDENT_CHILDRENNumber of Dependent Children0
... SELF_HELP_ATTENDANCESelf Help Attendance (Last 30 days at admission)/ Peer Support Attendance4
... TOTAL_SUBSTANCE_USE_PRIOR_TREATMENTSubstance Use Prior Treatment (Total Lifetime admissions)2
... PSYCHIATRIC_HOSPITAL_ADMISSIONPsychiatric Hospital Admission (Last 30 days)false
... LEGAL_STATUSLegal StatusBHA Legal Status: 02 (Court-directed voluntary)
... CRIMINAL_JUSTICE_INVOLVEMENTCriminal Justice Involvementfalse
... EDUCATION_LEVELEducation LevelBHA Education Level: 14 (Some College)
... SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)BHA School Attendance Status: 03 (Not Applicable)
... PSYCHIATRIC_ER_VISIT_6_MONTHSVisit to Psychiatric ER in last 6 months0
... COMMUNICATION_ACCOMMODATIONSCommunication Accommodationsfalse
... episodeOfCareEpisode of Care InformationEpisodeOfCare: status = finished; type = Substance Use Disorder; period = 2023-06-01 --> 2025-02-18
... diagnosisDiagnosis InformationOther psychoactive substance dependence, uncomplicated

doco Documentation for this format

Generated Narrative: QuestionnaireResponse BHASubstanceUseDisorderQuestionnaireResponseExampleNorth

LinkIDTextDefinitionAnswerdoco
.. BHASubstanceUseDisorderQuestionnaireResponseExampleNorthQuestionnaire:BHA Substance Use Disorder Questionnaire
... lastUpdated2025-02-18T10:15:00Z
... ASAM_LEVEL_OF_CAREASAM Level of Care: the ASAM Level of Care must match the LADDERS Provider/Clinic's ASAM Level of CareBHA ASAM Levels of Care: 2.1 (ASAM Level 2.1 - Intensive Outpatient Services (IOP))
... PRIMARY_SUBSTANCE_USEPrimary Substance UseBHA Substance Use Codes: 1 (Alcohol)
... PRIMARY_LAST_USED_30_DAYSTimes Used Primary Substance in Last 30 Days3
... PRIMARY_ROUTE_OF_USERoute of Use of Primary SubstancesBHA Substance Use Route of Administration Codes: 1 (Oral)
... PRIMARY_START_AGEAge of First Use of Primary Substances28
... SECONDARY_SUBSTANCE_USESecondary Substance UseBHA Substance Use Codes: 6 (Other tranquilizer)
... SECONDARY_LAST_USED_30_DAYSTimes Used Secondary Substance in Last 30 Days4
... SECONDARY_ROUTE_OF_USERoute of Use of Secondary SubstancesBHA Substance Use Route of Administration Codes: 3 (Inhalation (nose/mouth))
... SECONDARY_START_AGEAge of First Use of Secondary Substances28
... TERTIARY_SUBSTANCE_USETertiary Substance UseBHA Substance Use Codes: 10 (Other stimulants)
... TERTIARY_LAST_USED_30_DAYSTimes Used Tertiary Substance in Last 30 Days2
... TERTIARY_ROUTE_OF_USERoute of Use of Tertiary SubstanceBHA Substance Use Route of Administration Codes: 1 (Oral)
... TERTIARY_START_AGEAge of First Use of Tertiary Substance29
... episodeOfCareEpisode of Care InformationEpisodeOfCare: status = finished; type = Substance Use Disorder; period = 2023-06-01 --> 2025-02-18

doco Documentation for this format

Generated Narrative: QuestionnaireResponse BHADischargeQuestionnaireResponseExampleNorth

LinkIDTextDefinitionAnswerdoco
.. BHADischargeQuestionnaireResponseExampleNorthQuestionnaire:BHA Discharge Questionnaire
... lastUpdated2025-02-18T18:00:00Z
... DATE_OF_LAST_CONTACTDate of Last Contact2025-02-18T16:45:00Z
... DISCHARGE_DATEDischarge Date2025-02-18T18:00:00Z
... DISCHARGE_TYPEDischarge TypeBHA Discharge Type: 01 (Treatment Completed At This Facility)
... END_OF_TREATMENT_REASONEnd of Treatment ReasonBHA End of Treatment Reasons: 2 (Client Decision)
... ARRESTS_PAST_30_DAYSArrests in Past 30 Days1
... EMPLOYMENT_STATUSEmployment StatusBHA Employment Status: 01 (Employed Full Time (35+ hours/week))
... LIVING_SITUATIONLiving SituationBHA Living Situation: 1 (Correctional facility / Jail)
... SELF_HELP_ATTENDANCESelf Help Attendance / Peer Support Attendance (Last 30 days at discharge)3
... EDUCATION_LEVELEducation LevelBHA Education Level: 14 (Some College)
... SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)BHA School Attendance Status: 03 (Not Applicable)
... LEGAL_STATUSLegal StatusBHA Legal Status: 02 (Court-directed voluntary)
... episodeOfCareEpisode of Care InformationEpisodeOfCare: status = finished; type = Substance Use Disorder; period = 2023-06-01 --> 2025-02-18
... diagnosisDiagnosis InformationOther psychoactive substance dependence, uncomplicated

doco Documentation for this format