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

Example QuestionnaireResponse: Example BHA Admission Questionnaire Responses Central

Page standards status: Informative
LinkIDTextDefinitionAnswerdoco
BHAAdmissionQuestionnaireResponseExampleCentralQuestionnaire:BHA Admission Questionnaire
BHAAdmissionQuestionnaireResponseExampleCentral / lastUpdated2025-03-03T09:30:00Z
BHAAdmissionQuestionnaireResponseExampleCentral / SERVICE_IDENTIFIERService IdentifierBHA Service Identifier Codes: 30 (Mental Health Outpatient)
BHAAdmissionQuestionnaireResponseExampleCentral / FIRST_CONTACT_DATEDate of First Contact2023-01-15
BHAAdmissionQuestionnaireResponseExampleCentral / FIRST_APPOINTMENT_OFFERED_DATEDate of First Appointment Offered2023-01-20
BHAAdmissionQuestionnaireResponseExampleCentral / MEDICATION_ASSISTED_THERAPYMedication Assisted Therapyfalse
BHAAdmissionQuestionnaireResponseExampleCentral / REFERRAL_SOURCEReferral SourceBHA Referral Source: 1 (Individual (self, family, friend))
BHAAdmissionQuestionnaireResponseExampleCentral / ARRESTS_PAST_30_DAYSArrests in Past 30 Days0
BHAAdmissionQuestionnaireResponseExampleCentral / EMPLOYMENT_STATUSEmployment StatusBHA Employment Status: 02 (Employed Part Time (<35 hours/week))
BHAAdmissionQuestionnaireResponseExampleCentral / LIVING_SITUATIONLiving SituationBHA Living Situation: 2 (Inpatient)
BHAAdmissionQuestionnaireResponseExampleCentral / MONTHLY_INCOMEMonthly Income2800
BHAAdmissionQuestionnaireResponseExampleCentral / PRIMARY_INCOME_SOURCEPrimary Source of income/support for client (or for client's parent if client >18 years of age)BHA Income Source: 1 (Wages)
BHAAdmissionQuestionnaireResponseExampleCentral / PREGNANCY_STATUSPregnancy Statusfalse
BHAAdmissionQuestionnaireResponseExampleCentral / WITHIN_1_YEAR_POSTPARTUM_STATUSWithin 1 Year Postpartum Statusfalse
BHAAdmissionQuestionnaireResponseExampleCentral / SPECIAL_CONNECTIONS_ENROLLMENTEnrollment in Special Connectionsfalse
BHAAdmissionQuestionnaireResponseExampleCentral / ACT_ENROLLMENTEnrollment in ACT?false
BHAAdmissionQuestionnaireResponseExampleCentral / ASCENT_ENROLLMENTEnrollment in Ascent (FEP)?false
BHAAdmissionQuestionnaireResponseExampleCentral / NUMBER_DEPENDENT_CHILDRENNumber of Dependent Children0
BHAAdmissionQuestionnaireResponseExampleCentral / SELF_HELP_ATTENDANCESelf Help Attendance (Last 30 days at admission)/ Peer Support Attendance2
BHAAdmissionQuestionnaireResponseExampleCentral / TOTAL_SUBSTANCE_USE_PRIOR_TREATMENTSubstance Use Prior Treatment (Total Lifetime admissions)0
BHAAdmissionQuestionnaireResponseExampleCentral / PSYCHIATRIC_HOSPITAL_ADMISSIONPsychiatric Hospital Admission (Last 30 days)false
BHAAdmissionQuestionnaireResponseExampleCentral / LEGAL_STATUSLegal StatusBHA Legal Status: 02 (Court-directed voluntary)
BHAAdmissionQuestionnaireResponseExampleCentral / CRIMINAL_JUSTICE_INVOLVEMENTCriminal Justice Involvementfalse
BHAAdmissionQuestionnaireResponseExampleCentral / EDUCATION_LEVELEducation LevelBHA Education Level: 14 (Some College)
BHAAdmissionQuestionnaireResponseExampleCentral / SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)BHA School Attendance Status: 03 (Not Applicable)
BHAAdmissionQuestionnaireResponseExampleCentral / PSYCHIATRIC_ER_VISIT_6_MONTHSVisit to Psychiatric ER in last 6 months0
BHAAdmissionQuestionnaireResponseExampleCentral / COMMUNICATION_ACCOMMODATIONSCommunication Accommodationsfalse
BHAAdmissionQuestionnaireResponseExampleCentral / episodeOfCareEpisode of Care InformationEpisodeOfCare: status = finished; type = Mental Health; period = 2023-01-15 --> 2025-03-03
BHAAdmissionQuestionnaireResponseExampleCentral / diagnosisDiagnosis InformationMental disorder, not otherwise specified

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