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

- example BHA Admission Questionnaire Response

Profile: SDCBaseQuestionnaireversion: null3.0.0)

LinkID | Text | Cardinality | Type | Description & Constraints
--- | --- | --- | --- | ---
BHAAdmissionQuestionnaire | Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services |  | Questionnaire | http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire#0.1.0-current
FIRST_CONTACT_DATE | Date of First Contact | 1..1 | date | Value Set:
FIRST_APPOINTMENT_OFFERED_DATE | Date of First Appointment Offered | 1..1 | date | Value Set:
MEDICATION_ASSISTED_OPIOID_THERAPY | Medication Assisted Opioid Therapy | 1..1 | boolean | Value Set:
REFERRAL_SOURCE | Referral Source | 1..1 | choice | Value Set: BHA Referral Source
ARRESTS_PAST_30_DAYS | Arrests in Past 30 Days | 1..1 | integer | Value Set:
EMPLOYMENT_STATUS | Employment Status | 1..1 | choice | Value Set: BHA Employment Status
MARITAL_STATUS | Marital Status | 1..1 | choice | Value Set: BHA Marital Status
LIVING_SITUATION | Living Situation | 1..1 | choice | Value Set: BHA Living Situation
MONTHLY_INCOME | Monthly Income | 0..1 | decimal | Value Set:
PRIMARY_INCOME_SOURCE | Primary Source of income/support for client (or for client's parent if client >18 years of age) | 1..1 | choice | Value Set: BHA Income Source
PREGNANCY_STATUS | Pregnancy Status | 1..1 | boolean | Value Set:
WITHIN_1_YEAR_POSTPARTUM_STATUS | Within 1 Year Postpartum Status | 1..1 | boolean | Value Set:
SPECIAL_CONNECTIONS_ENROLLMENT | Enrollment in Special Connections | 1..1 | boolean | Value Set:
ACT_ENROLLMENT | Enrollment in ACT? | 1..1 | boolean | Value Set:
ASCENT_ENROLLMENT | Enrollment in Ascent (FEP)? | 1..1 | boolean | Value Set:
NUMBER_DEPENDENT_CHILDREN | Number of Dependent Children | 1..1 | integer | Value Set:
SELF_HELP_ATTENDANCE | Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance | 1..1 | integer | Value Set:
TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT | Substance Use Prior Treatment (Total Lifetime admissions) | 1..1 | integer | Value Set:
PSYCHIATRIC_HOSPITAL_ADMISSION | Psychiatric Hospital Admission (Last 30 days) | 1..1 | boolean | Value Set:
LEGAL_STATUS | Legal Status | 1..1 | choice | Value Set: BHA Legal Status
INVOLUNTARY_COMMITMENT_REASON | Involuntary Commitment Reason | 1..1 | choice | Enable When: LEGAL_STATUS = LEGAL_STATUS = LEGAL_STATUS = LEGAL_STATUS = Value Set: BHA Involuntary Reason
CRIMINAL_JUSTICE_INVOLVEMENT | Criminal Justice Involvement | 0..1 | boolean | Value Set:
EDUCATION_LEVEL | Education Level | 1..1 | choice | Value Set: BHA Education Level
SCHOOL_ATTENDANCE_STATUS | School Attendance Status (in the previous 3 months) | 1..1 | choice | Value Set: BHA School Attendance Status
PSYCHIATRIC_ER_VISIT_6_MONTHS | Visit to Psychiatric ER in last 6 months | 1..1 | integer | Value Set:
COMMUNICATION_ACCOMMODATIONS | Communication Accommodations | 0..1 | boolean | Value Set:
Documentation for this format