Behavioral Health Administration admission questionnaire for collecting patient demographic, clinical, and administrative information

Behavioral Health Administration client questionnaire for collecting patient demographic, clinical, and administrative information

Behavioral Health Administration diagnosis questionnaire for collecting patient clinical information during a behavioral health episode of care

Behavioral Health Administration discharge questionnaire for collecting patient demographic, clinical, and administrative information during discharge process

Behavioral Health Administration Special Connections baby questionnaire for collecting information about a baby born to a person enrolled in the Special Connections program

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

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

This profile specifies the mandatory and must support data elements for capturing demographic information for BHA clients in order to support the BHA's annual reporting requirements.

Encounter profile for client visits and encounters related to BHA EpisodeOfCare

Diagnosis profile for diagnoses related to BHA episodeOfCare

BHA EpisodeOfCare Profile for client admissions/services

Provider Organization profile for BHASO clinics

CCAR action type (admission, update, discharge, evaluation)

Allowed ethnicity values for BHA reporting

ValueSet for BHA gender identity codes

ValueSet for BHA household language codes

ValueSet for BHA sexual orientation codes

CPT, HCPCS, and ICD-10-CM codes referenced by CO BHA service identifier ConceptMaps.

All ICD-10-CM that are valid for Service Identifiers in CoBHRM

ASAM Levels of Care for BHA services/admissions (UDM format X(12)).

Value set for access to other drug/alcohol treatment used in BHA Special Connections

Allowed action type values for BHA CCAR reporting

Value set for children ages living in home used in BHA Special Connections

Allowed values for BHA client identifier types

Allowed client county values for BHA reporting

Types of diagnoses for BHA admissions

Disability codes for BHA admissions

Discharge type values for BHA reporting.

Value set for drug using partner used in BHA Special Connections

Value set for education levels used in BHA EpisodeOfCare. Valid values align with ACT sheet Appendix ACT-Ascent.

Value set for employment statuses used in BHA EpisodeOfCare

End of Treatment Reasons for BHA services/admissions. Valid values align with ACT sheet Appendix ACT-Ascent.

Value set for family substance use disorder used in BHA Special Connections

Value set for family/social support used in BHA Special Connections

Value set for HIV risk used in BHA Special Connections

Value set for home stability and safety used in BHA Special Connections

Value set for income sources used in BHA admission process

Value set for reasons for involuntary commitments used in BHA admission process

Value set for legal statuses used in BHA EpisodeOfCare

Value set for living situations used in BHA EpisodeOfCare

Value set for marital statuses used in BHA admission process

Value set for mental health history used in BHA Special Connections

Value set for personal safety used in BHA Special Connections

Value set for pregnancy / postpartum status used in BHA Special Connections Pregnancy/Postpartum Risk Screening Questionnaire

Value set for pregnancy/postpartum care status used in BHA Special Connections

Substance use codes for primary substance for BHA services/admissions

Value set for prior alcohol/drug treatment used in BHA Special Connections

Value set for prior criminal record used in BHA Special Connections

Allowed race values for BHA reporting

Value set for referral sources used in BHA admission process

SMI / SED Statuses for BHA services/admissions.

Value set for school attendance statuses used in BHA EpisodeOfCare

Substance use codes for secondary and tertiary substance for BHA services/admissions

Service identifiers for BHA services/admissions

Substance use routes of administration for BHA services/admissions.

ASAM Levels of Care for BHA services/admissions (UDM format X(12)).

Code system for access to other drug/alcohol treatment used in BHA Special Connections

CCAR action types

Code system for children ages living in home used in BHA Special Connections

Identifier types used for BHA client identifiers

County codes used by BHA

Types of diagnoses for BHA admissions.

Types of disabilities for BHA admissions.

Discharge type values for BHA reporting.

Code system for drug using partner used in BHA Special Connections

Code system for education levels used in BHA EpisodeOfCare. Valid values align with ACT sheet Appendix ACT-Ascent.

Code system for employment statuses used in BHA EpisodeOfCare

End of Treatment Reasons for BHA services/admissions. Valid values align with ACT sheet Appendix ACT-Ascent.

Ethnicity codes used by BHA

Code system for family substance use disorder used in BHA Special Connections

Code system for family/social support used in BHA Special Connections

Gender identity values used by BHA

Code system for HIV risk used in BHA Special Connections

Code system for home stability and safety used in BHA Special Connections

Household language codes used by BHA

Code system for income sources used in BHA admission process

Code system for involuntary commitment reasons used in BHA admission process

Code system for legal statuses used in BHA EpisodeOfCare

Code system for living situations used in BHA EpisodeOfCare

Code system for marital statuses used in BHA admission process

Code system for mental health history used in BHA Special Connections

Code system for personal safety used in BHA Special Connections

Code system for pregnancy / postpartum status used in BHA Special Connections Pregnancy/Postpartum Risk Screening Questionnaire

Code system for pregnancy/postpartum care status used in BHA Special Connections

Code system for prior alcohol/drug treatment used in BHA Special Connections

Code system for prior criminal record used in BHA Special Connections

Race codes used by BHA

Code system for referral sources used in BHA admission process

SMI / SED Statuses for BHA services/admissions.

Code system for school attendance statuses used in BHA EpisodeOfCare

Service identifiers for BHA services/admissions.

Sexual orientation values used by BHA

Substance use codes for BHA services/admissions.

Substance use routes of administration for BHA services/admissions.

Required: Maps BHA race codes to the US Core OMB race category value set.

Informative: Maps BHA education levels to HL7 v3 EducationLevel.

Required: Maps BHA ethnicity codes to the US Core OMB ethnicity category value set.

Required: Maps BHA ethnicity codes to the US Core detailed ethnicity value set.

Required: Maps BHA gender identity codes to the FHIR Gender Identity value set.

Required: Maps BHA household language codes to the US Core Primary Language value set which is BCP-47.

Required: Maps BHA marital status codes to the FHIR marital status value set.

Informative: Maps BHA service identifier codes to condition concepts from the US Core (SNOMED CT) condition code value set.

Required: Maps BHA sexual orientation codes to the US Core Sexual Orientation value set.

Informative: Maps BHA substance use routes of administration to HL7 v3 RouteOfAdministration.

Informative (Colorado): Maps CO BHA service identifier codes to related CPT and HCPCS procedure/service concepts used in Colorado implementation workflows.

Informative (Colorado): Maps CO BHA service identifier codes to related ICD-10-CM diagnosis concepts used in Colorado implementation workflows.

Example Responses to BHA Admission Questionnaire Questions

Example Client

Example Responses to BHA Client Questionnaire Questions

Second example Condition (encounter-diagnosis) for a BHA Episode with a Mental Health diagnosis type, illustrating multiple MH diagnoses for one episode.

Example Condition (encounter-diagnosis) for a BHA Episode with a Mental Health diagnosis type, illustrating use of the bha-diagnosis-type extension.

Example Condition (encounter-diagnosis) for a BHA Episode with a Substance Use Disorder diagnosis type, illustrating use of the bha-diagnosis-type extension.

Example Patient Resource for a Baby born to a BHA Client. This resource is referenced in the BHASCBabyQuestionnaireResponseResourceExample.

Example Responses to Diagnosis Questionnaire Questions

Example Responses to Discharge Questionnaire Questions

Example Encounter for a BHA Episode.

Example Encounter for a BHA Episode of both Behavioral Health and Pregnancy for a Pregnant Client. This encounter references both a BH episode of care and a pregnancy episode of care.

Example Episode of Care record for a BHA service/admission

Example Episode of Care resource for a pregnant client receiving BH services. This resource is referenced in the BHASCBabyQuestionnaireResponseExample and BHASCPregnancyQuestionnaireResponseExample.

Example Episode of Care resource for a substance use disorder treatment episode for a BHA client. This resource is referenced in the BHASubstanceUseDisorderQuestionnaireResponseExample.

Example Organization record for a BHA clinic.

Example Condition resource representing a pregnancy diagnosis, used in the EpisodeOfCareExamplePG to illustrate a non-BHA episode of care for a pregnant client receiving BH services.

Example Observation Record for pregnancy status

Example Responses to Special Connections Baby Questionnaire Questions that include a Reference to the Baby's Patient Resource.

Example Responses to Special Connections Baby Questionnaire Questions

Example Responses to Special Connections Pregnancy and Postpartum Risk Screening Questionnaire Questions

Example Responses to Special Connections Baby Questionnaire Questions, where there was a stillbirth.

Example Responses to Substance Use Disorder Questionnaire Questions

Second Example Encounter for a BHA Episode, illustrating multiple encounters for one episode.