Colorado BHA FHIR Implementation Guide
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Colorado BHA FHIR Implementation Guide, published by Colorado Behavioral Health Administration. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/CoBHA/CoBHRM-FHIR-IG/ and changes regularly. See the Directory of published versions

Questionnaire: BHA Admission Questionnaire

Official URL: http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire Version: 0.2.0
Standards status: Trial-use Active as of 2025-12-13 Maturity Level: 1 Computable Name: BHAAdmissionQuestionnaire

Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services

LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. BHAAdmissionQuestionnaire Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services Questionnaire http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire#0.2.0
... lastUpdated Last Updated DateTime of the data in the QuestionnaireResponse 1..1 dateTime Value Set:
... FIRST_CONTACT_DATE Date of First Contact 1..1 date Value Set:
... FIRST_APPOINTMENT_OFFERED_DATE Date of First Appointment Offered 1..1 date Value Set:
... MEDICATION_ASSISTED_OPIOID_THERAPY Medication Assisted Opioid Therapy 1..1 boolean Value Set:
... REFERRAL_SOURCE Referral Source 1..1 choice Value Set: ValueSet for BHA Referral Source
... ARRESTS_PAST_30_DAYS Arrests in Past 30 Days 1..1 integer Value Set:
... EMPLOYMENT_STATUS Employment Status 1..1 choice Value Set: ValueSet for BHA Employment Status
... MARITAL_STATUS Marital Status 1..1 choice Value Set: ValueSet for BHA Marital Status
... LIVING_SITUATION Living Situation 1..1 choice Value Set: ValueSet for BHA Living Situation
... MONTHLY_INCOME Monthly Income 0..1 decimal Value Set:
... PRIMARY_INCOME_SOURCE Primary Source of income/support for client (or for client's parent if client >18 years of age) 1..1 choice Value Set: ValueSet for BHA Income Source
... PREGNANCY_STATUS Pregnancy Status 1..1 boolean Value Set:
... WITHIN_1_YEAR_POSTPARTUM_STATUS Within 1 Year Postpartum Status 1..1 boolean Value Set:
... SPECIAL_CONNECTIONS_ENROLLMENT Enrollment in Special Connections 1..1 boolean Value Set:
... ACT_ENROLLMENT Enrollment in ACT? 1..1 boolean Value Set:
... ASCENT_ENROLLMENT Enrollment in Ascent (FEP)? 1..1 boolean Value Set:
... NUMBER_DEPENDENT_CHILDREN Number of Dependent Children 1..1 integer Value Set:
... SELF_HELP_ATTENDANCE Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance 1..1 integer Value Set:
... TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT Substance Use Prior Treatment (Total Lifetime admissions) 1..1 integer Value Set:
... PSYCHIATRIC_HOSPITAL_ADMISSION Psychiatric Hospital Admission (Last 30 days) 1..1 boolean Value Set:
... LEGAL_STATUS Legal Status 1..1 choice Value Set: ValueSet for BHA Legal Status
... INVOLUNTARY_COMMITMENT_REASON Involuntary Commitment Reason 1..1 choice Enable When:
  • LEGAL_STATUS = 72-hour evaluation and treatment (BHA Legal Status#04)
  • LEGAL_STATUS = Short-term certification (BHA Legal Status#05)
  • LEGAL_STATUS = Long-term certification (BHA Legal Status#06)
  • LEGAL_STATUS = Emergency/Involuntary Alcohol/Drug Commitment (BHA Legal Status#09)

Value Set: ValueSet for BHA Involuntary Commitment Reason
... CRIMINAL_JUSTICE_INVOLVEMENT Criminal Justice Involvement 0..1 boolean Value Set:
... EDUCATION_LEVEL Education Level 1..1 choice Value Set: ValueSet for BHA Education Level
... SCHOOL_ATTENDANCE_STATUS School Attendance Status (in the previous 3 months) 1..1 choice Value Set: ValueSet for BHA School Attendance Status
... PSYCHIATRIC_ER_VISIT_6_MONTHS Visit to Psychiatric ER in last 6 months 1..1 integer Value Set:
... COMMUNICATION_ACCOMMODATIONS Communication Accommodations 0..1 boolean Value Set:

doco Documentation for this format

Last Updated DateTime of the data in the QuestionnaireResponse*

  • linkId: lastUpdated
  • Answers:

Date of First Contact*

  • linkId: FIRST_CONTACT_DATE
  • Answers:

Date of First Appointment Offered*

  • linkId: FIRST_APPOINTMENT_OFFERED_DATE
  • Answers:

Medication Assisted Opioid Therapy*

  • linkId: MEDICATION_ASSISTED_OPIOID_THERAPY
  • Answers:

Referral Source*

Arrests in Past 30 Days*

  • linkId: ARRESTS_PAST_30_DAYS
  • Answers:

Employment Status*

Marital Status*

Living Situation*

Monthly Income

  • linkId: MONTHLY_INCOME
  • Answers:

Primary Source of income/support for client (or for client's parent if client >18 years of age)*

Pregnancy Status*

  • linkId: PREGNANCY_STATUS
  • Answers:

Within 1 Year Postpartum Status*

  • linkId: WITHIN_1_YEAR_POSTPARTUM_STATUS
  • Answers:

Enrollment in Special Connections*

  • linkId: SPECIAL_CONNECTIONS_ENROLLMENT
  • Answers:

Enrollment in ACT?*

  • linkId: ACT_ENROLLMENT
  • Answers:

Enrollment in Ascent (FEP)?*

  • linkId: ASCENT_ENROLLMENT
  • Answers:

Number of Dependent Children*

  • linkId: NUMBER_DEPENDENT_CHILDREN
  • Answers:

Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance*

  • linkId: SELF_HELP_ATTENDANCE
  • Answers:

Substance Use Prior Treatment (Total Lifetime admissions)*

  • linkId: TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT
  • Answers:

Psychiatric Hospital Admission (Last 30 days)*

  • linkId: PSYCHIATRIC_HOSPITAL_ADMISSION
  • Answers:

Legal Status*

Involuntary Commitment Reason*

Criminal Justice Involvement

  • linkId: CRIMINAL_JUSTICE_INVOLVEMENT
  • Answers:

Education Level*

School Attendance Status (in the previous 3 months)*

Visit to Psychiatric ER in last 6 months*

  • linkId: PSYCHIATRIC_ER_VISIT_6_MONTHS
  • Answers:

Communication Accommodations

  • linkId: COMMUNICATION_ACCOMMODATIONS
  • Answers:

LinkIDDescription & Constraintsdoco
.. lastUpdated Value Set:
.. FIRST_CONTACT_DATE Value Set:
.. FIRST_APPOINTMENT_OFFERED_DATE Value Set:
.. MEDICATION_ASSISTED_OPIOID_THERAPY Value Set:
.. REFERRAL_SOURCE Value Set: ValueSet for BHA Referral Source
.. ARRESTS_PAST_30_DAYS Value Set:
.. EMPLOYMENT_STATUS Value Set: ValueSet for BHA Employment Status
.. MARITAL_STATUS Value Set: ValueSet for BHA Marital Status
.. LIVING_SITUATION Value Set: ValueSet for BHA Living Situation
.. MONTHLY_INCOME Value Set:
.. PRIMARY_INCOME_SOURCE Value Set: ValueSet for BHA Income Source
.. PREGNANCY_STATUS Value Set:
.. WITHIN_1_YEAR_POSTPARTUM_STATUS Value Set:
.. SPECIAL_CONNECTIONS_ENROLLMENT Value Set:
.. ACT_ENROLLMENT Value Set:
.. ASCENT_ENROLLMENT Value Set:
.. NUMBER_DEPENDENT_CHILDREN Value Set:
.. SELF_HELP_ATTENDANCE Value Set:
.. TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT Value Set:
.. PSYCHIATRIC_HOSPITAL_ADMISSION Value Set:
.. LEGAL_STATUS Value Set: ValueSet for BHA Legal Status
.. INVOLUNTARY_COMMITMENT_REASON Enable When: Not done yet
Value Set: ValueSet for BHA Involuntary Commitment Reason
.. CRIMINAL_JUSTICE_INVOLVEMENT Value Set:
.. EDUCATION_LEVEL Value Set: ValueSet for BHA Education Level
.. SCHOOL_ATTENDANCE_STATUS Value Set: ValueSet for BHA School Attendance Status
.. PSYCHIATRIC_ER_VISIT_6_MONTHS Value Set:
.. COMMUNICATION_ACCOMMODATIONS Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire