Colorado BHA FHIR Implementation Guide
0.1.0-current - ci-build Unknown region code '840'

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 0.1.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RatioPBC/bha-ig/ and changes regularly. See the Directory of published versions

Questionnaire: BHA Admission Questionnaire

Official URL: http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire Version: 0.1.0-current
Standards status: Trial-use Maturity Level: 0 Computable Name: BHAAdmissionQuestionnaire

Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services

Example Questionnaire Responses

LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. BHAAdmissionQuestionnaireQuestionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health servicesQuestionnairehttp://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire#0.1.0-current
... FIRST_CONTACT_DATEDate of First Contact1..1dateValue Set:
... FIRST_APPOINTMENT_OFFERED_DATEDate of First Appointment Offered1..1dateValue Set:
... MEDICATION_ASSISTED_OPIOID_THERAPYMedication Assisted Opioid Therapy1..1booleanValue Set:
... ARRESTS_PAST_30_DAYSArrests in Past 30 Days1..1integerValue Set:
... EMPLOYMENT_STATUSEmployment Status1..1choiceValue Set: BHA Employment Status
... MARITAL_STATUSMarital Status1..1choiceValue Set: BHA Marital Status
... LIVING_SITUATIONLiving Situation1..1choiceValue Set: BHA Living Situation
... MONTHLY_INCOMEMonthly Income0..1decimalValue Set:
... PRIMARY_INCOME_SOURCEPrimary Source of income/support for client (or for client's parent if client >18 years of age)1..1choiceValue Set: BHA Income Source
... PREGNANCY_STATUSPregnancy Status1..1booleanValue Set:
... WITHIN_1_YEAR_POSTPARTUM_STATUSWithin 1 Year Postpartum Status1..1booleanValue Set:
... SPECIAL_CONNECTIONS_ENROLLMENTEnrollment in Special Connections1..1booleanValue Set:
... ACT_ENROLLMENTEnrollment in ACT?1..1booleanValue Set:
... ASCENT_ENROLLMENTEnrollment in Ascent (FEP)?1..1booleanValue Set:
... NUMBER_DEPENDENT_CHILDRENNumber of Dependent Children1..1integerValue Set:
... SELF_HELP_ATTENDANCESelf Help Attendance (Last 30 days at admission)/ Peer Support Attendance1..1integerValue Set:
... TOTAL_SUBSTANCE_USE_PRIOR_TREATMENTSubstance Use Prior Treatment (Total Lifetime admissions)1..1integerValue Set:
... PSYCHIATRIC_HOSPITAL_ADMISSIONPsychiatric Hospital Admission (Last 30 days)1..1booleanValue Set:
... LEGAL_STATUSLegal Status1..1choiceValue Set: BHA Legal Status
... INVOLUNTARY_COMMITMENT_REASONInvoluntary Commitment Reason1..1choiceEnable When:
Value Set: BHA Involuntary Reason
... CRIMINAL_JUSTICE_INVOLVEMENTCriminal Justice Involvement0..1booleanValue Set:
... EDUCATION_LEVELEducation Level1..1choiceValue Set: BHA Education Level
... SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)1..1choiceValue Set: BHA School Attendance Status
... PSYCHIATRIC_ER_VISIT_6_MONTHSVisit to Psychiatric ER in last 6 months1..1integerValue Set:
... COMMUNICATION_ACCOMMODATIONSCommunication Accommodations0..1booleanValue Set:

doco Documentation for this format