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

Page standards status: Informative
LinkIDTextDefinitionAnswerdoco
BHAAdmissionQuestionnaireResponseExampleQuestionnaire:BHA Admission Questionnaire
BHAAdmissionQuestionnaireResponseExample / lastUpdated2025-10-28T18:30:40-07:00
BHAAdmissionQuestionnaireResponseExample / SERVICE_IDENTIFIERService IdentifierBHA Service Identifier Codes: 30 (Mental Health Outpatient)
BHAAdmissionQuestionnaireResponseExample / FIRST_CONTACT_DATEDate of First Contact2025-07-01
BHAAdmissionQuestionnaireResponseExample / FIRST_APPOINTMENT_OFFERED_DATEDate of First Appointment Offered2025-07-15
BHAAdmissionQuestionnaireResponseExample / MEDICATION_ASSISTED_THERAPYMedication Assisted Therapytrue
BHAAdmissionQuestionnaireResponseExample / REFERRAL_SOURCEReferral SourceBHA Referral Source: 1 (Individual (self, family, friend))
BHAAdmissionQuestionnaireResponseExample / ARRESTS_PAST_30_DAYSArrests in Past 30 Days1
BHAAdmissionQuestionnaireResponseExample / EMPLOYMENT_STATUSEmployment StatusBHA Employment Status: 01 (Employed Full Time (35+ hours/week))
BHAAdmissionQuestionnaireResponseExample / LIVING_SITUATIONLiving SituationBHA Living Situation: 1 (Correctional facility / Jail)
BHAAdmissionQuestionnaireResponseExample / MONTHLY_INCOMEMonthly Income999
BHAAdmissionQuestionnaireResponseExample / 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)
BHAAdmissionQuestionnaireResponseExample / PREGNANCY_STATUSPregnancy Statusfalse
BHAAdmissionQuestionnaireResponseExample / WITHIN_1_YEAR_POSTPARTUM_STATUSWithin 1 Year Postpartum Statusfalse
BHAAdmissionQuestionnaireResponseExample / SPECIAL_CONNECTIONS_ENROLLMENTEnrollment in Special Connectionsfalse
BHAAdmissionQuestionnaireResponseExample / ACT_ENROLLMENTEnrollment in ACT?false
BHAAdmissionQuestionnaireResponseExample / ASCENT_ENROLLMENTEnrollment in Ascent (FEP)?false
BHAAdmissionQuestionnaireResponseExample / NUMBER_DEPENDENT_CHILDRENNumber of Dependent Children0
BHAAdmissionQuestionnaireResponseExample / SELF_HELP_ATTENDANCESelf Help Attendance (Last 30 days at admission)/ Peer Support Attendance0
BHAAdmissionQuestionnaireResponseExample / TOTAL_SUBSTANCE_USE_PRIOR_TREATMENTSubstance Use Prior Treatment (Total Lifetime admissions)9
BHAAdmissionQuestionnaireResponseExample / PSYCHIATRIC_HOSPITAL_ADMISSIONPsychiatric Hospital Admission (Last 30 days)true
BHAAdmissionQuestionnaireResponseExample / LEGAL_STATUSLegal StatusBHA Legal Status: 02 (Court-directed voluntary)
BHAAdmissionQuestionnaireResponseExample / CRIMINAL_JUSTICE_INVOLVEMENTCriminal Justice Involvementfalse
BHAAdmissionQuestionnaireResponseExample / EDUCATION_LEVELEducation LevelBHA Education Level: 14 (Some College)
BHAAdmissionQuestionnaireResponseExample / SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)BHA School Attendance Status: 03 (Not Applicable)
BHAAdmissionQuestionnaireResponseExample / PSYCHIATRIC_ER_VISIT_6_MONTHSVisit to Psychiatric ER in last 6 months0
BHAAdmissionQuestionnaireResponseExample / COMMUNICATION_ACCOMMODATIONSCommunication Accommodationstrue
BHAAdmissionQuestionnaireResponseExample / episodeOfCareEpisode of Care InformationEpisodeOfCare: status = finished; type = Mental Health; period = 2024-01-01 --> 2024-01-15
BHAAdmissionQuestionnaireResponseExample / diagnosisDiagnosis Information

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