Colorado BHA FHIR Implementation Guide
0.3.0-current - ci-build United States of America flag

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 Substance Use Disorder Questionnaire

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

Behavioral Health Administration substance use disorder questionnaire for collecting substance use information from a person receiving behavioral health services

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

LinkIDTextCardinalityTypeDescription & Constraintsdoco
BHASubstanceUseDisorderQuestionnaire Behavioral Health Administration substance use disorder questionnaire for collecting substance use information from a person receiving behavioral health services Questionnaire http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHASubstanceUseDisorderQuestionnaire#0.3.0-current
BHASubstanceUseDisorderQuestionnaire / lastUpdated Last Updated DateTime of the data in the QuestionnaireResponse 1..1 dateTime Value Set:
BHASubstanceUseDisorderQuestionnaire / ASAM_LEVEL_OF_CARE ASAM Level of Care: the ASAM Level of Care must match the LADDERS Provider/Clinic's ASAM Level of Care 0..1 choice Value Set: ValueSet for BHA ASAM Levels of Care
BHASubstanceUseDisorderQuestionnaire / PRIMARY_SUBSTANCE_USE Primary Substance Use 1..1 choice Value Set: ValueSet for BHA Primary Substance Use Codes
BHASubstanceUseDisorderQuestionnaire / PRIMARY_LAST_USED_30_DAYS Times Used Primary Substance in Last 30 Days 1..1 integer Enable When: PRIMARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set:
BHASubstanceUseDisorderQuestionnaire / PRIMARY_ROUTE_OF_USE Route of Use of Primary Substances 1..1 choice Enable When: PRIMARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set: ValueSet for BHA Substance Use Routes of Administration
BHASubstanceUseDisorderQuestionnaire / PRIMARY_START_AGE Age of First Use of Primary Substances 1..1 integer Enable When: PRIMARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set:
BHASubstanceUseDisorderQuestionnaire / SECONDARY_SUBSTANCE_USE Secondary Substance Use 1..1 choice Value Set: ValueSet for BHA Secondary and Tertiary Substance Use
BHASubstanceUseDisorderQuestionnaire / SECONDARY_LAST_USED_30_DAYS Times Used Secondary Substance in Last 30 Days 1..1 integer Enable When: SECONDARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set:
BHASubstanceUseDisorderQuestionnaire / SECONDARY_ROUTE_OF_USE Route of Use of Secondary Substances 1..1 choice Enable When: SECONDARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set: ValueSet for BHA Substance Use Routes of Administration
BHASubstanceUseDisorderQuestionnaire / SECONDARY_START_AGE Age of First Use of Secondary Substances 1..1 integer Enable When: SECONDARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set:
BHASubstanceUseDisorderQuestionnaire / TERTIARY_SUBSTANCE_USE Tertiary Substance Use 1..1 choice Value Set: ValueSet for BHA Secondary and Tertiary Substance Use
BHASubstanceUseDisorderQuestionnaire / TERTIARY_LAST_USED_30_DAYS Times Used Tertiary Substance in Last 30 Days 1..1 integer Enable When: TERTIARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set:
BHASubstanceUseDisorderQuestionnaire / TERTIARY_ROUTE_OF_USE Route of Use of Tertiary Substance 1..1 choice Enable When: TERTIARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set: ValueSet for BHA Substance Use Routes of Administration
BHASubstanceUseDisorderQuestionnaire / TERTIARY_START_AGE Age of First Use of Tertiary Substance 1..1 integer Enable When: TERTIARY_SUBSTANCE_USE != None (valid only for differential assessment) (BHA Substance Use Codes#0)
Value Set:
BHASubstanceUseDisorderQuestionnaire / episodeOfCare Episode of Care Information 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:

ASAM Level of Care: the ASAM Level of Care must match the LADDERS Provider/Clinic's ASAM Level of Care

Primary Substance Use*

Times Used Primary Substance in Last 30 Days*

  • linkId: PRIMARY_LAST_USED_30_DAYS
  • Enable When: todo
  • Answers:

Route of Use of Primary Substances*

Age of First Use of Primary Substances*

  • linkId: PRIMARY_START_AGE
  • Enable When: todo
  • Answers:

Secondary Substance Use*

Times Used Secondary Substance in Last 30 Days*

  • linkId: SECONDARY_LAST_USED_30_DAYS
  • Enable When: todo
  • Answers:

Route of Use of Secondary Substances*

Age of First Use of Secondary Substances*

  • linkId: SECONDARY_START_AGE
  • Enable When: todo
  • Answers:

Tertiary Substance Use*

Times Used Tertiary Substance in Last 30 Days*

  • linkId: TERTIARY_LAST_USED_30_DAYS
  • Enable When: todo
  • Answers:

Route of Use of Tertiary Substance*

Age of First Use of Tertiary Substance*

  • linkId: TERTIARY_START_AGE
  • Enable When: todo
  • Answers:

Episode of Care Information*

  • linkId: episodeOfCare
  • Answers:

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

LinkIDDescription & Constraintsdoco
lastUpdated Value Set:
ASAM_LEVEL_OF_CARE Value Set: ValueSet for BHA ASAM Levels of Care
PRIMARY_SUBSTANCE_USE Value Set: ValueSet for BHA Primary Substance Use Codes
PRIMARY_LAST_USED_30_DAYS Enable When: Not done yet
Value Set:
PRIMARY_ROUTE_OF_USE Enable When: Not done yet
Value Set: ValueSet for BHA Substance Use Routes of Administration
PRIMARY_START_AGE Enable When: Not done yet
Value Set:
SECONDARY_SUBSTANCE_USE Value Set: ValueSet for BHA Secondary and Tertiary Substance Use
SECONDARY_LAST_USED_30_DAYS Enable When: Not done yet
Value Set:
SECONDARY_ROUTE_OF_USE Enable When: Not done yet
Value Set: ValueSet for BHA Substance Use Routes of Administration
SECONDARY_START_AGE Enable When: Not done yet
Value Set:
TERTIARY_SUBSTANCE_USE Value Set: ValueSet for BHA Secondary and Tertiary Substance Use
TERTIARY_LAST_USED_30_DAYS Enable When: Not done yet
Value Set:
TERTIARY_ROUTE_OF_USE Enable When: Not done yet
Value Set: ValueSet for BHA Substance Use Routes of Administration
TERTIARY_START_AGE Enable When: Not done yet
Value Set:
episodeOfCare Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire