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 0.3.0-current 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 Special Connections Pregnancy/Postpartum Risk Screening Questionnaire

Official URL: http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHASCPregnancyPostpartumRiskQuestionnaire Version: 0.3.0-current
Standards status: Trial-use Maturity Level: 1 Computable Name: BHASCPregnancyPostpartumRiskQuestionnaire

Behavioral Health Administration Special Connections Pregnancy/Postpartum Risk Screening questionnaire for collecting information about a pregnant or postpartum person's risk factors

Profile: SDC Base Questionnaire version: 4.0.0-ci-build

LinkIDTextCardinalityTypeDescription & Constraintsdoco
BHASCPregnancyPostpartumRiskQuestionnaire Behavioral Health Administration Special Connections Pregnancy/Postpartum Risk Screening questionnaire for collecting information about a pregnant or postpartum person's risk factors Questionnaire http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHASCPregnancyPostpartumRiskQuestionnaire#0.3.0-current
BHASCPregnancyPostpartumRiskQuestionnaire / lastUpdated Last Updated DateTime of the data in the QuestionnaireResponse 1..1 dateTime Value Set:
BHASCPregnancyPostpartumRiskQuestionnaire / EVALUATION_DATE Evaluation Date 1..1 date Value Set:
BHASCPregnancyPostpartumRiskQuestionnaire / PREGNANCY_POSTPARTUM_STATUS Pregnancy/Postpartum Status 1..1 choice Value Set: ValueSet for BHA Pregnancy / Postpartum Status
BHASCPregnancyPostpartumRiskQuestionnaire / PREGNANCY_POSTPARTUM_CARE_STATUS Pregnancy/Postpartum Care Status 1..1 choice Value Set: ValueSet for BHA Pregnancy/Postpartum Care Status
BHASCPregnancyPostpartumRiskQuestionnaire / DRUG_ALCOHOL_TREATMENT_ACCESS Access to other drug/alcohol treatment 1..1 choice Value Set: ValueSet for BHA Access to Other Drug/Alcohol Treatment
BHASCPregnancyPostpartumRiskQuestionnaire / FAMILY_SOCIAL_SUPPORT Family/Social Support 1..1 choice Value Set: ValueSet for BHA Family/Social Support
BHASCPregnancyPostpartumRiskQuestionnaire / FAMILY_SUD_HISTORY Family substance use disorder history 1..* choice Value Set: ValueSet for BHA Family Substance Use Disorder
BHASCPregnancyPostpartumRiskQuestionnaire / FAMILY_SUD_CURRENT Family substance use disorder current 1..* choice Value Set: ValueSet for BHA Family Substance Use Disorder
BHASCPregnancyPostpartumRiskQuestionnaire / DRUG_USING_PARTNER Drug using partner 1..1 choice Value Set: ValueSet for BHA Drug Using Partner
BHASCPregnancyPostpartumRiskQuestionnaire / HIV_RISK HIV Risk 1..1 choice Value Set: ValueSet for BHA HIV Risk
BHASCPregnancyPostpartumRiskQuestionnaire / HOME_STABILITY_SAFETY Home Stability and Safety 1..1 choice Value Set: ValueSet for BHA Home Stability and Safety
BHASCPregnancyPostpartumRiskQuestionnaire / PERSONAL_SAFETY Personal Safety 1..1 choice Value Set: ValueSet for BHA Personal Safety
BHASCPregnancyPostpartumRiskQuestionnaire / PRIOR_CRIMINAL_RECORD Prior Criminal Record 1..1 choice Value Set: ValueSet for BHA Prior Criminal Record
BHASCPregnancyPostpartumRiskQuestionnaire / MENTAL_HEALTH_HISTORY Mental Health History 1..1 choice Value Set: ValueSet for BHA Mental Health History
BHASCPregnancyPostpartumRiskQuestionnaire / PRIOR_ALCOHOL_DRUG_TREATMENT Prior alcohol/drug treatment 1..1 choice Value Set: ValueSet for BHA Prior Alcohol/Drug Treatment
BHASCPregnancyPostpartumRiskQuestionnaire / CHILDREN_LIVING_WITH_CLIENT Children Living in home with you 1..1 boolean Value Set:
BHASCPregnancyPostpartumRiskQuestionnaire / CHILDREN_AGES_LIVING_WITH_CLIENT Children Ages living in home with you 1..* choice Enable When: CHILDREN_LIVING_WITH_CLIENT = true
Value Set: ValueSet for BHA Children Ages Living in Home
BHASCPregnancyPostpartumRiskQuestionnaire / episodeOfCare Episode of Care Information 1..1 reference Value Set:

doco Documentation for this format

Profile: SDC Base Questionnaire version: 4.0.0-ci-build

Last Updated DateTime of the data in the QuestionnaireResponse*

  • linkId: lastUpdated
  • Answers:

Evaluation Date*

  • linkId: EVALUATION_DATE
  • Answers:

Pregnancy/Postpartum Status*

Pregnancy/Postpartum Care Status*

Access to other drug/alcohol treatment*

Family/Social Support*

Family substance use disorder history*

Family substance use disorder current*

Drug using partner*

HIV Risk*

Home Stability and Safety*

Personal Safety*

Prior Criminal Record*

Mental Health History*

Prior alcohol/drug treatment*

Children Living in home with you*

  • linkId: CHILDREN_LIVING_WITH_CLIENT
  • Answers:

Children Ages living in home with you*

Episode of Care Information*

  • linkId: episodeOfCare
  • Answers:

Profile: SDC Base Questionnaire version: 4.0.0-ci-build

LinkIDDescription & Constraintsdoco
lastUpdated Value Set:
EVALUATION_DATE Value Set:
PREGNANCY_POSTPARTUM_STATUS Value Set: ValueSet for BHA Pregnancy / Postpartum Status
PREGNANCY_POSTPARTUM_CARE_STATUS Value Set: ValueSet for BHA Pregnancy/Postpartum Care Status
DRUG_ALCOHOL_TREATMENT_ACCESS Value Set: ValueSet for BHA Access to Other Drug/Alcohol Treatment
FAMILY_SOCIAL_SUPPORT Value Set: ValueSet for BHA Family/Social Support
FAMILY_SUD_HISTORY Value Set: ValueSet for BHA Family Substance Use Disorder
FAMILY_SUD_CURRENT Value Set: ValueSet for BHA Family Substance Use Disorder
DRUG_USING_PARTNER Value Set: ValueSet for BHA Drug Using Partner
HIV_RISK Value Set: ValueSet for BHA HIV Risk
HOME_STABILITY_SAFETY Value Set: ValueSet for BHA Home Stability and Safety
PERSONAL_SAFETY Value Set: ValueSet for BHA Personal Safety
PRIOR_CRIMINAL_RECORD Value Set: ValueSet for BHA Prior Criminal Record
MENTAL_HEALTH_HISTORY Value Set: ValueSet for BHA Mental Health History
PRIOR_ALCOHOL_DRUG_TREATMENT Value Set: ValueSet for BHA Prior Alcohol/Drug Treatment
CHILDREN_LIVING_WITH_CLIENT Value Set:
CHILDREN_AGES_LIVING_WITH_CLIENT Enable When: Not done yet
Value Set: ValueSet for BHA Children Ages Living in Home
episodeOfCare Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire