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

Example QuestionnaireResponse: Example BHA Admission Questionnaire Responses North

Page standards status: Informative
LinkIDTextDefinitionAnswerdoco
BHAAdmissionQuestionnaireResponseExampleNorthQuestionnaire:BHA Admission Questionnaire
BHAAdmissionQuestionnaireResponseExampleNorth / lastUpdated2025-02-18T10:15:00Z
BHAAdmissionQuestionnaireResponseExampleNorth / SERVICE_IDENTIFIERService IdentifierBHA Service Identifier Codes: 09 (SUD Intensive Outpatient (IOP))
BHAAdmissionQuestionnaireResponseExampleNorth / FIRST_CONTACT_DATEDate of First Contact2023-06-01
BHAAdmissionQuestionnaireResponseExampleNorth / FIRST_APPOINTMENT_OFFERED_DATEDate of First Appointment Offered2023-06-05
BHAAdmissionQuestionnaireResponseExampleNorth / MEDICATION_ASSISTED_THERAPYMedication Assisted Therapytrue
BHAAdmissionQuestionnaireResponseExampleNorth / REFERRAL_SOURCEReferral SourceBHA Referral Source: 1 (Individual (self, family, friend))
BHAAdmissionQuestionnaireResponseExampleNorth / ARRESTS_PAST_30_DAYSArrests in Past 30 Days1
BHAAdmissionQuestionnaireResponseExampleNorth / EMPLOYMENT_STATUSEmployment StatusBHA Employment Status: 01 (Employed Full Time (35+ hours/week))
BHAAdmissionQuestionnaireResponseExampleNorth / LIVING_SITUATIONLiving SituationBHA Living Situation: 1 (Correctional facility / Jail)
BHAAdmissionQuestionnaireResponseExampleNorth / MONTHLY_INCOMEMonthly Income1200
BHAAdmissionQuestionnaireResponseExampleNorth / PRIMARY_INCOME_SOURCEPrimary Source of income/support for client (or for client's parent if client >18 years of age)BHA Income Source: 2 (Public Assistance)
BHAAdmissionQuestionnaireResponseExampleNorth / PREGNANCY_STATUSPregnancy Statusfalse
BHAAdmissionQuestionnaireResponseExampleNorth / WITHIN_1_YEAR_POSTPARTUM_STATUSWithin 1 Year Postpartum Statusfalse
BHAAdmissionQuestionnaireResponseExampleNorth / SPECIAL_CONNECTIONS_ENROLLMENTEnrollment in Special Connectionsfalse
BHAAdmissionQuestionnaireResponseExampleNorth / ACT_ENROLLMENTEnrollment in ACT?false
BHAAdmissionQuestionnaireResponseExampleNorth / ASCENT_ENROLLMENTEnrollment in Ascent (FEP)?false
BHAAdmissionQuestionnaireResponseExampleNorth / NUMBER_DEPENDENT_CHILDRENNumber of Dependent Children0
BHAAdmissionQuestionnaireResponseExampleNorth / SELF_HELP_ATTENDANCESelf Help Attendance (Last 30 days at admission)/ Peer Support Attendance4
BHAAdmissionQuestionnaireResponseExampleNorth / TOTAL_SUBSTANCE_USE_PRIOR_TREATMENTSubstance Use Prior Treatment (Total Lifetime admissions)2
BHAAdmissionQuestionnaireResponseExampleNorth / PSYCHIATRIC_HOSPITAL_ADMISSIONPsychiatric Hospital Admission (Last 30 days)false
BHAAdmissionQuestionnaireResponseExampleNorth / LEGAL_STATUSLegal StatusBHA Legal Status: 02 (Court-directed voluntary)
BHAAdmissionQuestionnaireResponseExampleNorth / CRIMINAL_JUSTICE_INVOLVEMENTCriminal Justice Involvementfalse
BHAAdmissionQuestionnaireResponseExampleNorth / EDUCATION_LEVELEducation LevelBHA Education Level: 14 (Some College)
BHAAdmissionQuestionnaireResponseExampleNorth / SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)BHA School Attendance Status: 03 (Not Applicable)
BHAAdmissionQuestionnaireResponseExampleNorth / PSYCHIATRIC_ER_VISIT_6_MONTHSVisit to Psychiatric ER in last 6 months0
BHAAdmissionQuestionnaireResponseExampleNorth / COMMUNICATION_ACCOMMODATIONSCommunication Accommodationsfalse
BHAAdmissionQuestionnaireResponseExampleNorth / episodeOfCareEpisode of Care InformationEpisodeOfCare: status = finished; type = Substance Use Disorder; period = 2023-06-01 --> 2025-02-18
BHAAdmissionQuestionnaireResponseExampleNorth / diagnosisDiagnosis InformationOther psychoactive substance dependence, uncomplicated

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