BHA Substance Use Disorder Questionnaire - XML Representation - Colorado BHA FHIR Implementation Guide v0.3.0-current

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
: BHA Substance Use Disorder Questionnaire

Page standards status: Trial-use
Maturity Level: 1
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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="BHASubstanceUseDisorderQuestionnaire"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|4.0.0-ci-build"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire BHASubstanceUseDisorderQuestionnaire</b></p><a name="BHASubstanceUseDisorderQuestionnaire"> </a><a name="hcBHASubstanceUseDisorderQuestionnaire"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/HL7/sdc/StructureDefinition-sdc-questionnaire.html">SDC Base Questionnaire</a> version: 4.0.0-ci-build</p></div><table border="1" cellpadding="0" cellspacing="0" class="xhtTableBorder1"><tr class="xhtRowBorder2"><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck1.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="" style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> BHASubstanceUseDisorderQuestionnaire</td><td style="" class="hierarchy xhtCellBorder1">Behavioral Health Administration substance use disorder questionnaire for collecting substance use information from a person receiving behavioral health services</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">Questionnaire</td><td style="" class="hierarchy xhtCellBorder1">http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHASubstanceUseDisorderQuestionnaire#0.3.0-current</td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.lastUpdated" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-datetime.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="dateTime" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>lastUpdated</td><td style="" class="hierarchy xhtCellBorder1">Last Updated DateTime of the data in the QuestionnaireResponse</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-dateTime">dateTime</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.ASAM_LEVEL_OF_CARE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>ASAM_LEVEL_OF_CARE</td><td style="" class="hierarchy xhtCellBorder1">ASAM Level of Care: the ASAM Level of Care must match the LADDERS Provider/Clinic's ASAM Level of Care</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Value Set: <a href="ValueSet-bha-asam-level-of-care-vs.html">ValueSet for BHA ASAM Levels of Care</a></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.PRIMARY_SUBSTANCE_USE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>PRIMARY_SUBSTANCE_USE</td><td style="" class="hierarchy xhtCellBorder1">Primary Substance Use</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Value Set: <a href="ValueSet-bha-substance-use-primary-vs.html">ValueSet for BHA Primary Substance Use Codes</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.PRIMARY_LAST_USED_30_DAYS" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="" style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>PRIMARY_LAST_USED_30_DAYS</td><td style="" class="hierarchy xhtCellBorder1">Times Used Primary Substance in Last 30 Days</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.PRIMARY_SUBSTANCE_USE">PRIMARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.PRIMARY_ROUTE_OF_USE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>PRIMARY_ROUTE_OF_USE</td><td style="" class="hierarchy xhtCellBorder1">Route of Use of Primary Substances</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.PRIMARY_SUBSTANCE_USE">PRIMARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span><br/>Value Set: <a href="ValueSet-bha-substance-use-route-of-administration-vs.html">ValueSet for BHA Substance Use Routes of Administration</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.PRIMARY_START_AGE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="" style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>PRIMARY_START_AGE</td><td style="" class="hierarchy xhtCellBorder1">Age of First Use of Primary Substances</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.PRIMARY_SUBSTANCE_USE">PRIMARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.SECONDARY_SUBSTANCE_USE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>SECONDARY_SUBSTANCE_USE</td><td style="" class="hierarchy xhtCellBorder1">Secondary Substance Use</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Value Set: <a href="ValueSet-bha-substance-use-secondary-tertiary-vs.html">ValueSet for BHA Secondary and Tertiary Substance Use</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.SECONDARY_LAST_USED_30_DAYS" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="" style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>SECONDARY_LAST_USED_30_DAYS</td><td style="" class="hierarchy xhtCellBorder1">Times Used Secondary Substance in Last 30 Days</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.SECONDARY_SUBSTANCE_USE">SECONDARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.SECONDARY_ROUTE_OF_USE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>SECONDARY_ROUTE_OF_USE</td><td style="" class="hierarchy xhtCellBorder1">Route of Use of Secondary Substances</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.SECONDARY_SUBSTANCE_USE">SECONDARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span><br/>Value Set: <a href="ValueSet-bha-substance-use-route-of-administration-vs.html">ValueSet for BHA Substance Use Routes of Administration</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.SECONDARY_START_AGE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="" style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>SECONDARY_START_AGE</td><td style="" class="hierarchy xhtCellBorder1">Age of First Use of Secondary Substances</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.SECONDARY_SUBSTANCE_USE">SECONDARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.TERTIARY_SUBSTANCE_USE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>TERTIARY_SUBSTANCE_USE</td><td style="" class="hierarchy xhtCellBorder1">Tertiary Substance Use</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Value Set: <a href="ValueSet-bha-substance-use-secondary-tertiary-vs.html">ValueSet for BHA Secondary and Tertiary Substance Use</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.TERTIARY_LAST_USED_30_DAYS" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="" style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>TERTIARY_LAST_USED_30_DAYS</td><td style="" class="hierarchy xhtCellBorder1">Times Used Tertiary Substance in Last 30 Days</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.TERTIARY_SUBSTANCE_USE">TERTIARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" id="item.TERTIARY_ROUTE_OF_USE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>TERTIARY_ROUTE_OF_USE</td><td style="" class="hierarchy xhtCellBorder1">Route of Use of Tertiary Substance</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.TERTIARY_SUBSTANCE_USE">TERTIARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span><br/>Value Set: <a href="ValueSet-bha-substance-use-route-of-administration-vs.html">ValueSet for BHA Substance Use Routes of Administration</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" id="item.TERTIARY_START_AGE" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="" style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>TERTIARY_START_AGE</td><td style="" class="hierarchy xhtCellBorder1">Age of First Use of Tertiary Substance</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="" class="hierarchy xhtCellBorder1">Enable When: <span><a href="#item.TERTIARY_SUBSTANCE_USE">TERTIARY_SUBSTANCE_USE</a> != None (valid only for differential assessment) (BHA Substance Use Codes#0)</span></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck00.png)" id="item.episodeOfCare" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-reference.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="reference" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">BHASubstanceUseDisorderQuestionnaire / </span>episodeOfCare</td><td style="" class="hierarchy xhtCellBorder1">Episode of Care Information</td><td style="" class="hierarchy xhtCellBorder1">1..*</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-reference">reference</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm">
    <valueCoding>
      <system value="http://hl7.org/fhir/version-algorithm"/>
      <code value="semver"/>
      <display value="SemVer"/>
    </valueCoding>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://bha.colorado.gov/fhir/bha-ig/ImplementationGuide/us.co.bha-ig"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://bha.colorado.gov/fhir/bha-ig/ImplementationGuide/us.co.bha-ig"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHASubstanceUseDisorderQuestionnaire"/>
  <version value="0.3.0-current"/>
  <name value="BHASubstanceUseDisorderQuestionnaire"/>
  <title value="BHA Substance Use Disorder Questionnaire"/>
  <status value="active"/>
  <subjectType value="Patient"/>
  <date value="2025-12-17"/>
  <publisher value="Colorado Behavioral Health Administration"/>
  <contact>
    <name value="Colorado Behavioral Health Administration"/>
    <telecom>
      <system value="url"/>
      <value value="https://bha.colorado.gov"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="FHIRFeedback@state.co.us"/>
    </telecom>
  </contact>
  <description
               value="Behavioral Health Administration substance use disorder questionnaire for collecting substance use information from a person receiving behavioral health services"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="USA"/>
    </coding>
  </jurisdiction>
  <item>
    <linkId value="lastUpdated"/>
    <text
          value="Last Updated DateTime of the data in the QuestionnaireResponse"/>
    <type value="dateTime"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="ASAM_LEVEL_OF_CARE"/>
    <text
          value="ASAM Level of Care: the ASAM Level of Care must match the LADDERS Provider/Clinic's ASAM Level of Care"/>
    <type value="choice"/>
    <required value="false"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-asam-level-of-care-vs"/>
  </item>
  <item>
    <linkId value="PRIMARY_SUBSTANCE_USE"/>
    <text value="Primary Substance Use"/>
    <type value="choice"/>
    <required value="true"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-substance-use-primary-vs"/>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/minValue">
      <valueInteger value="0"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/maxValue">
      <valueInteger value="30"/>
    </extension>
    <linkId value="PRIMARY_LAST_USED_30_DAYS"/>
    <text value="Times Used Primary Substance in Last 30 Days"/>
    <type value="integer"/>
    <enableWhen>
      <question value="PRIMARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="PRIMARY_ROUTE_OF_USE"/>
    <text value="Route of Use of Primary Substances"/>
    <type value="choice"/>
    <enableWhen>
      <question value="PRIMARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-substance-use-route-of-administration-vs"/>
  </item>
  <item>
    <linkId value="PRIMARY_START_AGE"/>
    <text value="Age of First Use of Primary Substances"/>
    <type value="integer"/>
    <enableWhen>
      <question value="PRIMARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="SECONDARY_SUBSTANCE_USE"/>
    <text value="Secondary Substance Use"/>
    <type value="choice"/>
    <required value="true"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-substance-use-secondary-tertiary-vs"/>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/minValue">
      <valueInteger value="0"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/maxValue">
      <valueInteger value="30"/>
    </extension>
    <linkId value="SECONDARY_LAST_USED_30_DAYS"/>
    <text value="Times Used Secondary Substance in Last 30 Days"/>
    <type value="integer"/>
    <enableWhen>
      <question value="SECONDARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="SECONDARY_ROUTE_OF_USE"/>
    <text value="Route of Use of Secondary Substances"/>
    <type value="choice"/>
    <enableWhen>
      <question value="SECONDARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-substance-use-route-of-administration-vs"/>
  </item>
  <item>
    <linkId value="SECONDARY_START_AGE"/>
    <text value="Age of First Use of Secondary Substances"/>
    <type value="integer"/>
    <enableWhen>
      <question value="SECONDARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="TERTIARY_SUBSTANCE_USE"/>
    <text value="Tertiary Substance Use"/>
    <type value="choice"/>
    <required value="true"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-substance-use-secondary-tertiary-vs"/>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/minValue">
      <valueInteger value="0"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/maxValue">
      <valueInteger value="30"/>
    </extension>
    <linkId value="TERTIARY_LAST_USED_30_DAYS"/>
    <text value="Times Used Tertiary Substance in Last 30 Days"/>
    <type value="integer"/>
    <enableWhen>
      <question value="TERTIARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="TERTIARY_ROUTE_OF_USE"/>
    <text value="Route of Use of Tertiary Substance"/>
    <type value="choice"/>
    <enableWhen>
      <question value="TERTIARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
    <answerValueSet
                    value="http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-substance-use-route-of-administration-vs"/>
  </item>
  <item>
    <linkId value="TERTIARY_START_AGE"/>
    <text value="Age of First Use of Tertiary Substance"/>
    <type value="integer"/>
    <enableWhen>
      <question value="TERTIARY_SUBSTANCE_USE"/>
      <operator value="!="/>
      <answerCoding>
        <system
                value="http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-substance-use-cs"/>
        <code value="0"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource">
      <valueCode value="EpisodeOfCare"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile">
      <valueCanonical
                      value="http://bha.colorado.gov/fhir/bha-ig/StructureDefinition/bha-episodeOfCare"/>
    </extension>
    <linkId value="episodeOfCare"/>
    <text value="Episode of Care Information"/>
    <type value="reference"/>
    <required value="true"/>
    <repeats value="true"/>
  </item>
</Questionnaire>