HAB Client Report Without Data Systems

Data Elements for Client-level Data Export (Submitted to OMB)
A client report must be submitted by all agencies that provide services directly to clients. This document outlines the
data fields that will be submitted in the XML file. The client report will contain one de-identified record for each
client who received a Ryan White HIV/AIDS Program-funded core medical service or support service during the
reporting period.
The data elements reported per client will depend upon the specific RWHAP-funded service(s) the client received at
the agency. HAB used the Privacy Rule’s safe-harbor method of de-identification as a guide when determining the
client level data elements to be reported by Ryan White Program service providers. The information being reported
in the selected client level data elements cannot be used alone or in combination to re identify specific Ryan White
clients. For detailed information about these data elements and reporting client-level data, refer to “The Client
Report” section in the RSR Instruction Manual.
Note: For the first two RSR reporting periods (January–June 2009 and January–December 2009), only service
providers receiving RWHAP funds to provide outpatient/ambulatory medical care and/or case management services
(medical or non-medical) will be required to submit a Client Report.
Field #

Variable Description

SV1

Reporting Period

SV2

Unique Provider ID

Coding

Rationale1

Jan 1 – Jun 30, 20XX
Jan 1 – Dec 31, 20XX

unique provider number
Client Demographics
SV3

Unique client ID (UCI)

TBD

1.

Date of client’s first service
visit at this provider’s agency
or organization

__/__/____
MM/DD/YYYY
(If only month and year
are known, enter “01”
as the day.)
Unknown

Draft for OMB 11-05-2008

Necessary for identifying new clients
2006 Ryan White Legislation
requirement
Necessary for all performance
measures relevant to new clients
as required for:
• GPRA
• PART
• HAB Core Clinical
Performance Measures Group
1

1

Field #
2.

Coding

Rationale1

Active, continuing in
program
Referred to another
program or services, or
became self-sufficient
Removed from treatment
due to violation of
rules
Incarcerated
Relocated
Deceased
Unknown

Necessary to track enrollment or vital
status over the course of the
reporting period

Variable Description
What was the client’s vital
enrollment status at the end of
this reporting period?

Informs the denominator of other
items

3.

If response is “deceased” in
Q2, then answer: What was
the client’s date of death, if
known?

__/__/____
MM/DD/YYYY

4.

Client’s year of birth

_____
YYYY

Used to identify important population
subgroups

Unknown

2006 Ryan White Legislation
requirement

5.

What is the client’s ethnicity?

Hispanic/Latino
Non-Hispanic/Latino
Unknown

Used to identify important population
subgroups
2006 Ryan White Legislation
requirement
Necessary for all performance
measures relevant to new clients
as required for:
• PART

6.

What is the client’s race?
(Select one or more)

Draft for OMB 11-05-2008

White
Black or African
American
Asian
Native Hawaiian/
Pacific Islander
American Indian or
Alaska Native
Unknown

Used to identify important population
subgroups
Necessary for performance measures
relevant to ethnicity as required
for:
• PART

2

Field #
7.

Variable Description
What is the client’s current
gender?

Coding

Rationale1

Male
Female
Transgender
Unknown

Used to identify important population
subgroups
2006 Ryan White Legislation
requirement

8.

If response is “Transgender”
in Q7, then answer: What is
the client’s transgender
subgroup, if known?

Male to female
Female to male

Necessary for performance measures
relevant to gender as required for:
• GPRA
• PART
• HAB Core Clinical
Performance Measures Group
1

9.

Client’s percent of the Federal
poverty level at the end of the
reporting period

Equal to or below the
Federal poverty level
101-200% of the Federal
poverty level
201-300% of the Federal
poverty level
More than 300% of the
Federal poverty level
Unknown

Used to identify an important
population subgroup

Client’s housing status at the
end of the reporting period

Stable/permanent
Temporary
Unstable
Unknown

Used to identify important population
subgroups

10.

11.

What was the geographic unit
code of the client’s residence at
the end of this reporting
period?

__ __ __

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement
Used to measure and assess the extent
of out-of-service area utilization.
Used to determine areas of eligibility

If the client’s housing is
“unstable,” enter the
geographic unit code of the
place the client considered
his/her residence or “home
base” at the end of this
reporting period.

Draft for OMB 11-05-2008

3

Field #
12.

Variable Description

Coding

Rationale1

What was the client’s
HIV/AIDS status at the end of
the reporting period?

HIV negative
HIV +, not AIDS
HIV-positive, AIDS
status unknown
CDC-defined AIDS
HIV indeterminate
(infants only)
Unknown

13.

If response is “CDC-defined
AIDS” in Q12, then answer:
What is the year of the client’s
AIDS diagnosis, if known?

_____
YYYY

14.

What is the client’s risk factor
for HIV infection (select one or
more)

Male who has sex
with male(s) (MSM)
Injecting drug use
(IDU)
Hemophilia/
coagulation disorder
Heterosexual contact
Receipt of blood
transfusion, blood
components, or tissue
Mother w/at risk for
HIV infection
(perinatal
transmission)
Other
Unknown

Used to identify important population
subgroups

15.

Indicate all sources of the
client’s health insurance during
this reporting period:

Private
Medicare
Medicaid
Other Public
No Insurance
Other
Unknown

Used to identify important population
subgroups

Draft for OMB 11-05-2008

2006 Ryan White Legislation
requirement
Necessary for all performance
measures relevant to HIV/AIDS
status as required for:
• PART
• HAB Core Clinical
performance measures Group
1

2006 Ryan White Legislation
requirement

4

Field #

Variable Description

Coding

Rationale1

Core Services:
Only report data for the services your agency has been funded to provide.
16.

Outpatient ambulatory health
services

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds
2006 Ryan White Legislation
requirement
Necessary for performance measures
relevant to number of visits as
required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

17.

18.

19.

20.

21.

22.

23.

24.

Oral health care

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Early intervention services
(Parts A and B)

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Home health care

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Home and community-based
health services

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Hospice services

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Mental health services

Medical nutrition therapy

Medical case management
(including treatment adherence)

Draft for OMB 11-05-2008

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

5

Field #
25.

26.

27.

Variable Description

Coding

Rationale1

Substance abuse services-outpatient

Number of visits in each
quarter of reporting
period
___ ___

Accountability, use of funds

Did the client receive Local
AIDS Pharmaceutical
Assistance (APA, not ADAP)
at any time during each quarter
of this reporting period?

Yes
No
Unknown
___ ___

Accountability, use of funds

Was Health Insurance Program
(HIP) funding provided for this
client each quarter during this
reporting period?

Yes
No
Unknown
___ ___

Accountability, use of funds

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

Support Services:
Only report data for the services your agency has been funded to provide.
28.

29.

30.

31.

32.

33.

34.

Received Case management
(non-medical) services each
quarter during this reporting
period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Child care services
each quarter during this
reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Developmental
assessment/ early intervention
services each quarter during
this reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Emergency financial
assistance each quarter during
this reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Food bank/homedelivered meals each quarter
during this reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Health education/risk
reduction each quarter during
this reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Housing services
each quarter during this
reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Draft for OMB 11-05-2008

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

6

Field #
35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

Variable Description

Coding

Rationale1

Received Legal services each
quarter during this reporting
period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Linguistic services
each quarter during this
reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Transportation
services each quarter during
this reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Outreach services
each quarter during this
reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Permanency planning
each quarter during this
reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Psychosocial support
services each quarter during
this reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Referral for health
care/supportive services each
quarter during this reporting
period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received rehabilitation services
each quarter during this
reporting period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Respite care each
quarter during this reporting
period

Yes
No
Unknown
___ ___

Accountability, use of funds

Received Substance abuse
services—residential each
quarter during this reporting
period

Yes
No
Unknown
___ ___

Accountability, use of funds

Draft for OMB 11-05-2008

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

2006 Ryan White Legislation
requirement

7

Field #
45.

Variable Description
Received Treatment adherence
counseling each quarter during
this reporting period

Coding
Yes
No
Unknown
___ ___

Rationale1
Accountability, use of funds
2006 Ryan White Legislation
requirement

Clinical information:
Outpatient/ambulatory medical care providers should report clinical data for
HIV-positive and indeterminate clients only.
46.

47.

Was HIV risk reduction
screening/counseling provided
to this client during this
reporting period?

Yes
No
Unknown
______

2006 Ryan White Legislation
requirement

Date of the client’s first
outpatient /ambulatory care
visit at this provider agency

__/__/____
MM/DD/YYYY
(If only month and year
are known, enter “01”
as the day.)

2006 Ryan White Legislation
requirement

Unknown

Necessary for all performance
measures relevant to new clients
as required for:
• GPRA
• HAB Core Clinical
performance measures Group
1

Necessary for all performance
measures relevant to medical visits
as required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

48.

List all the dates of the client’s
outpatient ambulatory care
visits in this provider’s HIV
care setting with a clinical care
provider during this reporting
period.

__/__/____
MM/DD/YYYY

Necessary for performance measures
relevant to number of visits as
required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

49.

Report all CD4 counts and their
dates for this client during this
report period.

Value ____
Date __/__/____
MM/DD/YYYY

Necessary for performance measures
relevant to number of visits for
care as required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

Draft for OMB 11-05-2008

8

Field #

Variable Description

Coding

Rationale1

50.

Report all Viral Load counts
and their dates for this client
during this report period

Value ____
Date __/__/____
MM/DD/YYYY

Necessary for performance measures
relevant to number of visits for
care as required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

51.

Was the client prescribed PCP
prophylaxis at any time during
this reporting period?

Yes
No
Not medically
indicated
No, client refused
Unknown

Necessary for performance measures
relevant to PCP prophylaxis
screening as required for:
• GPRA
• HAB Core Clinical
performance measures Group
1

52.

Was the client prescribed
HAART at any time during this
reporting period?

Yes
No, not medically
indicated
No, not ready (as
determined by
clinician)
No, client refused
No, intolerance,
side-effect, toxicity
No, HAART payment
assistance unavailable
No, other reason
Unknown

Necessary for performance measures
relevant to client’s HAART status
as required in:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

53.

Was the client screened for TB
during this reporting period?

Yes
No
Not medically indicated
Unknown

54.

If response is “no” or “not
medically indicated” in Q53,
then answer: Has the client
been screened for TB since
his/her HIV diagnosis?

Yes
No
Not medically indicated
Unknown

Necessary for performance measures
relevant to TB screening as
required for:
• GPRA
• HAB Core Clinical
performance measures Group
2

55.

Was the client screened for
syphilis during this reporting
period? (exclude all clients
under the age of 18 who are not
sexually active)

Yes
No
Not medically indicated
Unknown

Draft for OMB 11-05-2008

Necessary for performance measures
relevant to syphilis screening as
required for:
• GPRA
• HAB Core Clinical
performance measures Group
2

9

Field #

Variable Description

Coding

Rationale1

56.

Was the client screened for
Hepatitis B during this
reporting period?

Yes
No
Not medically indicated
Unknown

57.

If response is “no” or “not
medically indicated” in Q56,
then answer: Was the client
screened for Hepatitis B since
his/her HIV diagnosis?

Yes
No
Not medically indicated
Unknown

58.

Has the client completed the
vaccine series for Hepatitis B?

Yes
No
Not medically indicated
Unknown

Necessary for performance measures
relevant to Hep B as required for:
• HAB Core Clinical
performance measures Group
2

59.

Was the client screened for
Hepatitis C during this
reporting period?

Yes
No
Not medically indicated
Unknown

60.

If response is no” or “not
medically indicated” in Q59,
then answer: Has the client
been screened for Hepatitis C
since his/her HIV diagnosis?

Yes
No
Not medically indicated
Unknown

Necessary for performance measures
relevant to TB screening as
required for:
• GPRA
• HAB Core Clinical
performance measures Group
2

61.

Was the client screened for
substance use (alcohol and
drugs) during this reporting
period?

Yes
No
Not medically indicated
Unknown

2006 Ryan White Legislation
requirement

Was the client screened for
mental health during this
reporting period?

Yes
No
Not medically indicated
Unknown

2006 Ryan White Legislation
requirement

62.

Draft for OMB 11-05-2008

Necessary for performance measures
relevant to Hep B screening as
required for:
• GPRA
• HAB Core Clinical
performance measures Group
3

Necessary for performance measures
relevant to substance use
screening as required for:
• GPRA
• HAB Core Clinical
performance measures Group
3

Necessary for performance measures
relevant to mental health screening
as required for:
• GPRA
• HAB Core Clinical
performance measures Group
3

10

Field #

Coding

Rationale1

63.

(For HIV+ women only) Did
the client receive a Pap smear
during this reporting period?

Yes
No
Not medically indicated
Not applicable
Unknown

Necessary for performance measures
relevant to Pap smears as required
for:
• GPRA
• HAB Core Clinical
performance measures Group
2

64.

(For HIV+ women only) Was
the client pregnant during this
reporting period?

Yes
No
Not applicable
Unknown

2006 Ryan White Legislation
requirement

(For HIV+ women only) If
response is “yes” in Q64, then
answer: When did the client
enter prenatal care?

First trimester
Second trimester
Third trimester
At time of delivery
Not applicable
Unknown

2006 Ryan White Legislation
requirement

(For HIV+ women only) If
response is “yes” in Q64, then
answer: Was the client
prescribed antiretroviral
therapy to prevent maternal to
child (vertical) transmission of
HIV?

Yes
No
Not applicable
Unknown

65.

66.

1

Variable Description

Necessary for all performance
measures relevant to pregnant
clients as required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

Necessary for all performance
measures relevant to appropriate
services to reduce perinatal
transmission as required for:
• GPRA
• PART
• HAB Core Clinical
performance measures Group
1

*

Ryan White legislation: Title XXVI of the PHS Act as amended by the Ryan White HIV/AIDS Treatment
Modernization Act of 2006.

*

GPRA: The Government Performance and Results Act (GPRA), enacted in 1993, requires Federal agencies
to establish standards measuring their performance and effectiveness.

*

PART: The Program Assessment Rating Tool (PART) was developed to assess and improve program
performance so that the Federal government can achieve better results.

*

HAB Core Clinical Performance Measures provide an indication of an organization’s performance in
relation to a specified process or outcome. HAB is releasing the performance measures in phases to allow
for staged implementation by service providers. Providers can review the HAB Core Clinical Performance
Measures that have been released at http://hab.hrsa.gov/special/habmeasures.htm.

Draft for OMB 11-05-2008

11