# BHA Client Questionnaire - Colorado BHA FHIR Implementation Guide v0.1.0-current

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **BHA Client Questionnaire**

## Questionnaire: BHA Client Questionnaire 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAClientQuestionnaire | *Version*:0.1.0-current | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](maturity.md): 0 | *Computable Name*:BHAClientQuestionnaire |

 
Questionnaire used during a behavioral health episode of care to collect demographic and administrative information from patients receiving behavioral health services 

### Example Questionnaire Responses

* [BHA Client Questionnaire Response](QuestionnaireResponse-BHAClientQuestionnaireResponseExample.md)



## Resource Content

```json
{
  "resourceType" : "Questionnaire",
  "id" : "BHAClientQuestionnaire",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|3.0.0"]
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 0,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://bha.colorado.gov/fhir/bha-ig/ImplementationGuide/bha-ig"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://bha.colorado.gov/fhir/bha-ig/ImplementationGuide/bha-ig"
      }]
    }
  }],
  "url" : "http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAClientQuestionnaire",
  "version" : "0.1.0-current",
  "name" : "BHAClientQuestionnaire",
  "title" : "BHA Client Questionnaire",
  "status" : "active",
  "subjectType" : ["Patient"],
  "date" : "2025-12-17",
  "publisher" : "Colorado Behavioral Health Administration",
  "contact" : [{
    "name" : "Colorado Behavioral Health Administration",
    "telecom" : [{
      "system" : "url",
      "value" : "https://bha.colorado.gov"
    },
    {
      "system" : "email",
      "value" : "FHIRFeedback@state.co.us"
    }]
  }],
  "description" : "Questionnaire used during a behavioral health episode of care to collect demographic and administrative information from patients receiving behavioral health services",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "840"
    }]
  }],
  "item" : [{
    "linkId" : "PEAK_ID",
    "text" : "Colorado PEAK State ID / Universal ID (MEDICAID ID)",
    "type" : "string",
    "required" : false
  },
  {
    "linkId" : "CCAR_ID",
    "text" : "CCAR Identifier (data conversion)",
    "type" : "string",
    "required" : false
  },
  {
    "linkId" : "DACODS_ID",
    "text" : "DACODS Identifier (data conversion)",
    "type" : "string",
    "required" : false
  },
  {
    "linkId" : "CHILD_WELFARE_INVOLVEMENT",
    "text" : "Child Welfare Involvement",
    "type" : "boolean",
    "required" : false
  },
  {
    "linkId" : "TRAILS_ID",
    "text" : "Trails Identifier",
    "type" : "string",
    "enableWhen" : [{
      "question" : "CHILD_WELFARE_INVOLVEMENT",
      "operator" : "=",
      "answerBoolean" : true
    }],
    "required" : true
  },
  {
    "linkId" : "DISABILITY_CODES",
    "text" : "Disability Code(s)",
    "type" : "choice",
    "required" : true,
    "repeats" : true,
    "answerValueSet" : "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-disability-codes-vs"
  }]
}

```
