Generated Narrative: Questionnaire BHAAdmissionQuestionnaire Profile: SDCBaseQuestionnaireversion: null3.0.0) LinkID Text Cardinality Type Description & Constraints 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#0.1.0-current #xD; lastUpdated Last Updated DateTime of the data in the QuestionnaireResponse 1..1 dateTime #xD; FIRST_CONTACT_DATE Date of First Contact 1..1 date #xD; FIRST_APPOINTMENT_OFFERED_DATE Date of First Appointment Offered 1..1 date #xD; MEDICATION_ASSISTED_OPIOID_THERAPY Medication Assisted Opioid Therapy 1..1 boolean #xD; REFERRAL_SOURCE Referral Source 1..1 choice Value Set: ValueSet for BHA Referral Source #xD; ARRESTS_PAST_30_DAYS Arrests in Past 30 Days 1..1 integer #xD; EMPLOYMENT_STATUS Employment Status 1..1 choice Value Set: ValueSet for BHA Employment Status #xD; MARITAL_STATUS Marital Status 1..1 choice Value Set: ValueSet for BHA Marital Status #xD; LIVING_SITUATION Living Situation 1..1 choice Value Set: ValueSet for BHA Living Situation #xD; MONTHLY_INCOME Monthly Income 0..1 decimal #xD; 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 #xD; PREGNANCY_STATUS Pregnancy Status 1..1 boolean #xD; WITHIN_1_YEAR_POSTPARTUM_STATUS Within 1 Year Postpartum Status 1..1 boolean #xD; SPECIAL_CONNECTIONS_ENROLLMENT Enrollment in Special Connections 1..1 boolean #xD; ACT_ENROLLMENT Enrollment in ACT? 1..1 boolean #xD; ASCENT_ENROLLMENT Enrollment in Ascent (FEP)? 1..1 boolean #xD; NUMBER_DEPENDENT_CHILDREN Number of Dependent Children 1..1 integer #xD; SELF_HELP_ATTENDANCE Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance 1..1 integer #xD; TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT Substance Use Prior Treatment (Total Lifetime admissions) 1..1 integer #xD; PSYCHIATRIC_HOSPITAL_ADMISSION Psychiatric Hospital Admission (Last 30 days) 1..1 boolean #xD; LEGAL_STATUS Legal Status 1..1 choice Value Set: ValueSet for BHA Legal Status #xD; INVOLUNTARY_COMMITMENT_REASON Involuntary Commitment Reason 1..1 choice Enable When: LEGAL_STATUS = LEGAL_STATUS = LEGAL_STATUS = LEGAL_STATUS = Value Set: ValueSet for BHA Involuntary Commitment Reason #xD; CRIMINAL_JUSTICE_INVOLVEMENT Criminal Justice Involvement 0..1 boolean #xD; EDUCATION_LEVEL Education Level 1..1 choice Value Set: ValueSet for BHA Education Level #xD; SCHOOL_ATTENDANCE_STATUS School Attendance Status (in the previous 3 months) 1..1 choice Value Set: ValueSet for BHA School Attendance Status #xD; PSYCHIATRIC_ER_VISIT_6_MONTHS Visit to Psychiatric ER in last 6 months 1..1 integer #xD; COMMUNICATION_ACCOMMODATIONS Communication Accommodations 0..1 boolean #xD; Documentation for this format
Colorado Behavioral Health Administration
Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services
Last Updated DateTime of the data in the QuestionnaireResponse
Primary Source of income/support for client (or for client's parent if client >18 years of age)
Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance
Substance Use Prior Treatment (Total Lifetime admissions)
Psychiatric Hospital Admission (Last 30 days)
Emergency/Involuntary Alcohol/Drug Commitment
School Attendance Status (in the previous 3 months)
Visit to Psychiatric ER in last 6 months