| OMB No. 0930-0335 | |||||||||
| Expiration Date: xx/xx/xx | |||||||||
| Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0335. Public reporting burden for this collection of information is estimated to average 10 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857. | |||||||||
| LEGEND | |||||||||
| Key field = must not be blank. Key fields, taken together, are used to uniquely identify and link records. | |||||||||
| Data set classifications, i.e., SDS, MDS, and SuDS, apply to MH-TEDS admission variables only. | |||||||||
| TEDS/MH-TEDS | MH-CLD | ||||||||
| Variable Name | Data Field Reference Number | Categories | Variable Name | Data Field Reference No. | Categories | ||||
| Admission Record | Discharge/Update Record | Data Files | |||||||
| Value taken from admission record | Value taken at time of discharge or data update | BCI | SHR | ||||||
| SYSTEM DATA SET (SDS) | |||||||||
| System Transaction Type | SDS 1 | DIS 1 | Transaction Type | C-00 | R-00 | ||||
| A=Add | A=Add | ||||||||
| C=Change | C=Change | ||||||||
| D=Delete | D=Delete | ||||||||
| State Code –- Key field | SDS 2 | DIS 2 | 2 alphanumeric | Reporting State Code | H-02 | H-01 | 2 alphanumeric | ||
| Reporting Date | SDS 3 | DIS 3 | MMYYYY | This information is contained in the file name algorithm | MMDDYYYY | ||||
| MINIMUM DATA SET (MDS) | |||||||||
| State Provider Identifier – Key field | MDS 1 | DIS 11 | DIS 4 | 1-15 alphanumeric | Not reported | ||||
| Client Identifier – Key field | MDS 2 | DIS 12 | DIS 5 | 1-15 alphanumeric | Client Identifier | C-01 | R-01 | 1-15 alphanumeric | |
| Codependent or Collateral – Key field | MDS 3 | DIS 13 | DIS 6 | 1=codependent/collateral 2=client | Not reported | ||||
| Client Transaction Type – Key field | MDS 4 | A=Initial Admission (SA) | Not reported | ||||||
| T=Transfer or change in service (SA) | |||||||||
| M=Initial Admission (MH) | |||||||||
| X=Transfer or change in service (MH) | |||||||||
| Date of Admission – Key field | MDS 5 | DIS 15 | MMDDYYYY | Client Status - at Start of Reporting Period (Dateof Admission is used by the state to report this translated variable) | C-02 | 1=New client | |||
| 2=Continuing client; | |||||||||
| Prior Treatment Episodes | MDS 6 | Optional reporting MH clients with co-occurring SA | Not reported | ||||||
| 0=0 Previous episodes | |||||||||
| 1=1 | |||||||||
| 2=2 | |||||||||
| 3=3 | |||||||||
| 4=4 | |||||||||
| 5=5 or more | |||||||||
| 7=unknown | |||||||||
| 8=not collected | |||||||||
| Referral Source | MDS 7 | Optional reporting for MH | Not reported | ||||||
| 01=Individual | |||||||||
| 02=Alcohol/drug abuse care provider | |||||||||
| 03=Other health care provider | |||||||||
| 04=School | |||||||||
| 05=Employer/EAP | |||||||||
| 06=Other community referral | |||||||||
| 07=court/criminal justice referral | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Date of Birth | MDS 8 | DIS 17 | MMDDYYYY | Age (Date of Birth is used by the state to report this calculated variable) | C-05 | ||||
| 01010007=unknown | |||||||||
| 01010008=not collected | |||||||||
| Gender | MDS 9 | DIS 18 | Gender | C-04 | |||||
| 1=male | 1=male | ||||||||
| 2=female | 2=female | ||||||||
| 7=unknown | 7=unknown | ||||||||
| 8=not collected | 8=not collected | ||||||||
| Race | MDS 10 | DIS 19 | Race | C-06 | |||||
| 01=Alaska Native | |||||||||
| 02=American Indian and Alaska Native | 02=American Indian and Alaska Native | ||||||||
| 13=Asian | 13=Asian | ||||||||
| 23=Native Hawaiian or other Pacific Islander | 23=Native Hawaiian or other Pacific Islander | ||||||||
| 03=Asian or Pacific Islander | 03=Asian or Pacific Islander (temporary code) | ||||||||
| 04= Black or African American | 04= Black or African American | ||||||||
| 05=White | 05=White | ||||||||
| 20=Other single race | 20=Some other race alone | ||||||||
| 21=Two or more races | 21=Two or more races | ||||||||
| 22=Hispanic (temporary code) | |||||||||
| 97=unknown | 97=unknown | ||||||||
| 98=not collected | 98=not collected | ||||||||
| Hispanic or Latino Origin (Ethnicity) | MDS 11 | DIS 20 | 01=Puerto Rico | Ethnicity | C-07 | 11=Puerto Rican (optional) | |||
| 02=Mexican | 12=Mexican (optional) | ||||||||
| 03=Cuban | 13=Cuban (optional) | ||||||||
| 04=Other Specific Hispanic or Latino | 14=Other Specific Hispanic | ||||||||
| 05 Not of Hispanic Origin | 02=Not of Hispanic Origin | ||||||||
| 06=Hispanic, specific origin not specified | 01=Hispanic origin regardless of race | ||||||||
| 97=unknown | 97=unknown | ||||||||
| 98=not collected | 98=Not collected | ||||||||
| Education | MDS 12 | MHD 5 | School Grade Level | C-25 | |||||
| 00= less than one grade completed or no schooling | 00=no years of schooling | ||||||||
| 01-11=grades 1 thru 11th | 01-11=grades 1 through 11th | ||||||||
| 12=12th grade or GED | 12 = 12th grade | ||||||||
| 13=Freshman or first year in a 2-year (Associate) Degree | 17=freshman (1st year in College) | ||||||||
| 14=Sophomore or second year in a 2-year (Associate) Degree | 18=sophomore (2nd year in College) | ||||||||
| 15=Junior in college | 19=junior (3rd year in College) | ||||||||
| 16=Senior in college or Bachelor's Degree | 20=senior (4th year in College) | ||||||||
| 17=Some Post-Graduate Study- Degree not completed | |||||||||
| 18= Master's Degree completed | |||||||||
| 19-25= Post graduate study | |||||||||
| 70= graduate or professional school (can be used instead of codes 17-25) | 21=Graduate or professional school | ||||||||
| 71=vocational school | 16=vocational school | ||||||||
| 72=nursery school, pre-school | 13=nursery school, pre-school (head start) | ||||||||
| 73=kindergarten | 14=kindergarten | ||||||||
| 74=self-contained special education class | 15=self-contained special education class | ||||||||
| 97=unknown | 97 = unknown | ||||||||
| 98=not collected | 98=not collected | ||||||||
| Employment Status | MDS 13 | DIS 24 | Competitive Employment Status at admission and end of the reporting period | C-09 and C-10 | |||||
| 01=full time | 01=full time | ||||||||
| 02=part-time | 02=part time | ||||||||
| 03=unemployed | 03=unemployed | ||||||||
| 04=not in the labor force | 84=not in the labor force | ||||||||
| 05=employed, full/part-time not specified (MH) | 05=employed, full/part-time not specified (temporary code) | ||||||||
| 97=unknown | 97=unknown | ||||||||
| 98=not collected | 98=not collected | ||||||||
| Substance Abuse Problem (Primary, Secondary, Tertiary) | MDS 14a MDS 14b MDS 14c | DIS 21a DIS 21b DIS 21c | Optional reporting for MH clients with co-occurring SA | ||||||
| 01=none | |||||||||
| 02=alcohol | |||||||||
| 03=cocaine/crack | |||||||||
| 04=marijuana/hashish | |||||||||
| 05=heroin | |||||||||
| 06=non-prescription methadone | |||||||||
| 07=other opiates and synthetics | |||||||||
| 08=PCP-phencyclidine | |||||||||
| 09=hallucinogens | |||||||||
| 10=methamphetamine/speed | |||||||||
| 11=other amphetamines | |||||||||
| 12=other stimulants | |||||||||
| 13=benzodiazepine | |||||||||
| 14=other tranquilizers | |||||||||
| 15=barbiturates | |||||||||
| 16=other sedatives or hypnotics | |||||||||
| 17=inhalants | |||||||||
| 18=over-the-counter medications | |||||||||
| 20=other drugs | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Route of Administration (Primary, Secondary, Tertiary Substances) | MDS 15a MDS 15b MDS 15c | Optional reporting for MH clients with co-occurring SA - see Manual for SA route of administration categories | Not reported | ||||||
| 01=oral | |||||||||
| 02=smoking | |||||||||
| 03=inhalation | |||||||||
| 04=injection | |||||||||
| 20=other | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Frequency of Use (Primary, Secondary, Tertiary Substances) | MDS 16a MDS 16b MDS 16c | DIS 22a DIS 22b DIS 22c | Optional reporting for MH clients with co-occurring SA - see Manual for SA frequency of use categories | Not reported | |||||
| 01=no use in the past month | |||||||||
| 02=1-3 days in the past month | |||||||||
| 03=1-2 days in the past week | |||||||||
| 04=3-6 days in the past week | |||||||||
| 05=daily | |||||||||
| 96=N/A | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Age at First Use (Primary, Secondary, Tertiary, Substances) | MDS 17a MDS 17b MDS 17c | Optional reporting for MH clients with co-occurring SA) | Not reported | ||||||
| 00=newborn with a substance dependency problem | |||||||||
| 01-95=age at first use, in years | |||||||||
| 96=N/A | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Type of Treatment Service/ Treatment Setting – Key field | MDS 18 | DIS 16 | DIS 7 | Not reported | |||||
| 01=detox, 24-hr, hospital | Service Setting Status Throughout the Reporting Period | C-15 | |||||||
| 02= detox, 24-hr, residential | |||||||||
| 03=rehabilitation/residential-hospital (not detox) | |||||||||
| 04=rehabilitation/residential-short term (<30 days) | |||||||||
| 05=rehabilitation/ residential-long term (>30 days) | |||||||||
| 06=ambulatory-intensive outpatient | |||||||||
| 07=ambulatory-non-intensive outpatient | |||||||||
| 08=ambulatory-detoxification | |||||||||
| 72=state psychiatric hospital | |||||||||
| 73=SMHA funded/operated community-based program | 1=state psychiatric hospital | ||||||||
| 74=residential treatment center | 2=SMHA funded/operated community-based program | ||||||||
| 75=other psychiatric inpatient | 3=residential treatment center | ||||||||
| 76=institutions under the justice system | 4=other psychiatric inpatient | ||||||||
| 96=Not applicable (use only for codependents or collateral clients (SA) and for MH clients receiving MH assessments, evaluation, or screening only) | 5=institutions under the justice system | ||||||||
| Medication-Assisted Opioid Therapy | MDS 19 | Optional reporting for MH clients with co-occurring SA | |||||||
| 1=Yes | Not reported | ||||||||
| 2=No | |||||||||
| 6=Not applicable | |||||||||
| 7=unknown | |||||||||
| 8=not collected | |||||||||
| SUPPLEMENTAL DATA SET (SuDS) | |||||||||
| Detailed Drug Code (Primary, Secondary, Tertiary) | SuDS 1 SuDS 2 SuDS 3 | Optional reporting for MH clients with co-occurring SA - see Manual for SA drug code categories | |||||||
| 0201=alcohol | |||||||||
| 0301=crack | |||||||||
| 0302=other cocaine | |||||||||
| 0401=marijuana/hashish | |||||||||
| 0501=heroin | |||||||||
| 0601=non-prescription methadone | |||||||||
| 0701=codeine | |||||||||
| 0702=propoxyphene | |||||||||
| 0703=oxycodone | |||||||||
| 0704=meperidine | |||||||||
| 0705=hydromorphone | |||||||||
| 0706=butorphanol, morphine, opium, and other narcotic analgesics, opiates or synthetics | |||||||||
| 0707=pentazocine | |||||||||
| 0708=hydrocodone | |||||||||
| 0709=tramadol | |||||||||
| 0710=buprenorphin (subutex, suboxone) | |||||||||
| 0801=PCP | |||||||||
| 0901=LSD | |||||||||
| 0902=DMT, mescaline, peyote, psilocybin, STD, and other hallucinogens | |||||||||
| 1001=methamphetamine/speed | |||||||||
| 1101=amphetamine | |||||||||
| 1103=Methylenedioxymethamphetamine (MDMA, Ecstasy) | |||||||||
| 1109="Bath Salts", phenmetrazine, and other amines and related drugs | |||||||||
| 1201=other stimulants | |||||||||
| 1202=Methylphenidate (Ritalin) | |||||||||
| 1301=Alprazolam (Xanax) | |||||||||
| 1302=Chlordiazepoxide (Librium) | |||||||||
| 1303=Clorazepate (Tranzene) | |||||||||
| 1304=Diazepam (Valium) | |||||||||
| 1305=Flurazepam (Dalmane) | |||||||||
| 1306=Lorazepam (Ativan) | |||||||||
| 1307=Triazolam (Halcion) | |||||||||
| 1308=Halazepam, oxazepam (Serax), prazepam, temazepam (Restoril), and other Benzodiazepines | |||||||||
| 1309=Flunitrazepam (Rohypnol) | |||||||||
| 1310=Clonazepam (Klonopin,Rivotril) | |||||||||
| 1401=Meprobamate (Miltown) | |||||||||
| 1403=Other non-benzodiazepine tranquilizers | |||||||||
| 1501=Phenobarbital | |||||||||
| 1502=Secobarbital/Amobarbital (Tuinal) | |||||||||
| 1503=Secobarbital (Seconal) | |||||||||
| 1509=Amobarbital, pentobarbital (Nembutal) and other barbiturate sedatives | |||||||||
| 1601=Ethchlorvynol (Placidyl) | |||||||||
| 1602=Glutethimide (Doriden) | |||||||||
| 1603=Methaqualone (Quaalude) | |||||||||
| 1604=Chloral hydrate and other Non-Barbiturate Sedatives/hypnotics | |||||||||
| 1701=Aerosols | |||||||||
| 1702=Nitrites | |||||||||
| 1703=Gasoline, glue, and other inappropriately inhaled products | |||||||||
| 1704=Solvents (paint thinner and other solvents) | |||||||||
| 1705=Anesthetics (chloroform, ether, nitrous oxide, and other anesthetics) |
|||||||||
| 1801=Diphenhydramine | |||||||||
| 1809=Other antihistamines, aspirin, Dextromethorphan (DXM) and other cough syrups, Ephedrine, sleep aids, and any other legally obtained, non-prescription medication | |||||||||
| 2001=Diphenylhydantoin/Phenytoin (Dilantin) | |||||||||
| 2002=Synthetic Cannabinoid "Spice", Carisoprodol (Soma) and other drugs |
|||||||||
| 2003=GHB/GBL (gamma-hydroxybutyrate, gammabutyrolactone) | |||||||||
| 2004=Ketamine (Special K) | |||||||||
| 9996=N/A | |||||||||
| 9997=unknown | |||||||||
| 9998=not collected | |||||||||
| Diagnostic Code (DSM/ICD) | SuDS 4 | xxx.xx, xxx.--, xxx.--, xxx.x- | Not reported | ||||||
| 999.97=unknown | Not reported | ||||||||
| 999.98=not collected | |||||||||
| Co-occurring substance abuse and mental health problems (old name in TEDS: Psychiatric problem in addition to alcohol and drug) | SuDS 5 | 1=yes | |||||||
| 2=no | Substance abuse problem | C-21 | 1=yes | ||||||
| 7=unknown | 2=no | ||||||||
| 8=not collected | 7=unknown | ||||||||
| Pregnant at Admission | SuDS 6 | Optional reporting for MH | 8=not collected | ||||||
| 1=Yes | Not reported | ||||||||
| 2=No | |||||||||
| 6=Not applicable | |||||||||
| 7=unknown | |||||||||
| 8=not collected | |||||||||
| Veteran Status | SuDS 7 | Optional reporting for MH | |||||||
| 1=Veteran | Not reported | ||||||||
| 2=Not a veteran | |||||||||
| 7=unknown | |||||||||
| 8=not collected | |||||||||
| Living Arrangements | SuDS 8 | DIS 23 | |||||||
| 01=homeless | Residential status at start and end of the reporting period | C-12 and C-13 | |||||||
| 02=dependent living (under age 18 living with parents, relatives, or guardians) | 01=homeless | ||||||||
| 22=dependent living: residential care and other residential status (MH only) | 37=private residence (children only) | ||||||||
| 03=residential care | |||||||||
| 32=dependent living: foster home/foster care (MH only) | 08=other residential status | ||||||||
| 42=dependent living: crisis residence (MH only) | 02=fosterhome/foster care | ||||||||
| 52=dependent living:institutional setting (MH only) | 04=crisis residence | ||||||||
| 62=dependent living: jail and other institutions under the justice system (MH only) | 05=institutional setting | ||||||||
| 72=dependent living: adults in private residence who needs assistance in daily living (MH only) | 06=jail/correctional facility | ||||||||
| 03=independent living | 27=private residence, dependent living (adult) | ||||||||
| 04=private residence, living arrangement not specified, adults (temporary code) | 17=private residence, independent living (adult) | ||||||||
| 97=unknown | 07=private residence, living arrangement not specified (adult) | ||||||||
| 98=not collected | 97=unknown | ||||||||
| Source of Income/Support | SuDS 9 | Optional reporting for MH | 98=not collected | ||||||
| 01=wages/salary | Not reported | ||||||||
| 02=public assistance | |||||||||
| 03=retirement/pension | |||||||||
| 04=disability | |||||||||
| 20=other | |||||||||
| 21=none | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Health Insurance | SuDS 10 | Optional reporting for MH | |||||||
| 01=private insurance | Not reported | ||||||||
| 02=Blue Cross/Blue Shield | |||||||||
| 03=Medicare | |||||||||
| 04=Medicaid | |||||||||
| 06=HMO | |||||||||
| 20=other | |||||||||
| 21=none | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Payment Source, Primary (Expected or Actual) | SuDS 11 | Optional reporting for MH | |||||||
| 01=self-pay | Not reported | ||||||||
| 02=Blue Cross/Blue Shield | |||||||||
| 03=Medicare | |||||||||
| 04=Medicaid | |||||||||
| 05=Other government payments | |||||||||
| 06=Worker's compensation | |||||||||
| 07=other health insurance companies | |||||||||
| 08=no charge | |||||||||
| 09=other | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Detailed Not-in-Labor Force | SuDS 12 | DIS 25 | |||||||
| 01=homemaker | Competitive Employment Status - at start and end of the reporting period (as a selection category) | C-09 and C-10 | |||||||
| 02=student | 14=homemaker | ||||||||
| 03=retired | 24=student | ||||||||
| 04=disabled | 34=retired | ||||||||
| 05= resident of institution or persons receiving services from institutional facilities such as hospitals, jails, prisons, etc. | 44=disabled | ||||||||
| 06=other | |||||||||
| 07=sheltered/non-competitive employment (MH only) | 64=other reported classification | ||||||||
| 96=not applicable (if employment status is not 04, NILF) | 74=sheltered/non-competitive employment | ||||||||
| 97=unknown | 96=not applicable | ||||||||
| 97=unknown | |||||||||
| 98=not collected | 84=NILF, classification not specified | ||||||||
| Detailed Criminal Justice Referral | SuDS 13 | Optional reporting for MH | 98=not collected | ||||||
| 01=state/federal court | Not reported | ||||||||
| 02=other court | |||||||||
| 03=probation/parole | |||||||||
| 04=other recognized legal entity | |||||||||
| 05=diversionary program | |||||||||
| 06=prison | |||||||||
| 07=DUI/DWI | |||||||||
| 08=other | |||||||||
| 96=not applicable | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Marital Status | SuDS 14 | Optional reporting for MH | |||||||
| 01=never married | Marital Status | O-01 | optional reporting | ||||||
| 02=now married/living as couple or cohabiting | 01=never married | ||||||||
| 03=separated | 02=married/living as couple | ||||||||
| 04=divorced | 03=separated | ||||||||
| 05=widowed | 04=divorced | ||||||||
| 97=unknown | 05=widowed | ||||||||
| 98=not collected | 97=unknown | ||||||||
| Days Waiting to Enter Treatment | SuDS 15 | optional reporting for MH clients with co-occurring SA | 98=not collected | ||||||
| 000-996=number of days waiting | Not reported | ||||||||
| 997=unknown | |||||||||
| 998=not collected | |||||||||
| Arrests in Past 30 Days | SuDS 16 | DIS 26 | |||||||
| 00-96=number of arrests | Number of Arrests in Prior 30 days - at start and end of the reporting period | C-22 and C-23 | |||||||
| 97=unknown | 00-96=number of arrests | ||||||||
| 98=not collected | 97=unknown | ||||||||
| Attendance at Self-Help Groups in Past 30 Days | SuDS 17 | DIS 27 | optional reporting for MH clients with co-occurring SA | 98=not collected | |||||
| 01=no attendance | Not reported | ||||||||
| 02=less than once a week | |||||||||
| 03=about once a week | |||||||||
| 04=2 to 3 times per week | |||||||||
| 05=at least 4 times a week | |||||||||
| 06=some attendance | |||||||||
| 97=unknown | |||||||||
| 98=not collected | |||||||||
| Diagnostic Code Set Identifier | SuDS 18 | MHD 1 | |||||||
| 1=DSM-IV | Diagnostic Code Identifier | H-08 | |||||||
| 2=ICD-9 | 1=DSM IV | ||||||||
| 3=ICD-10 | 2=ICD-9 | ||||||||
| 4=DSM-V | 3=ICD 10 | ||||||||
| 5=DSM-III R | 4=DSM V | ||||||||
| 7=unknown | |||||||||
| 8=not collected | |||||||||
| Diagnostic Code - ICD 10 Compatible, Substance Abuse | SuDS 19 | ||||||||
| xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx- | Substance Abuse Diagnosis | C-20 | |||||||
| xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx---- | |||||||||
| 999.9997=unknown | 999.9996=no substance abuse diagnosis | ||||||||
| 999.9998=not collected | 999.9997=unknown | ||||||||
| Other Variables | 999.9998=not collected | ||||||||
| Date of Discharge - Key field | DIS 9 | MMDDYYYY | |||||||
| Reason for Discharge, Transfer, or Discontinuance of Treatment | DIS 10 | 01=treatment completed | Client status - at end of the reporting period (Date of Discharge is used by the state to report this translated variable) | C-03 | |||||
| 02=dropped out of treatment | Discharge reasons | BCI (C-03) | SHR (R-03) | ||||||
| 03=terminated by facility | 12=treatment completed | 01=completed SH inpatient treatment | |||||||
| 04=transferred to another treatment program or facility provider | 22= lost contact or administrative discharge | 03=left against medical advise, eloped, failed to return from leave, non-compliance with treatment and/or policy; | |||||||
| 14=transferred to another treatment program/facility but did not report | 04=client choice | ||||||||
| 05=incarcerated or released by or to courts | 07=discharged to other inpatient provider | ||||||||
| 06=death | |||||||||
| 07=Other (includes aging out of the children's MH system, extended placement (conditional release), and all other reasons) | 32=discharged to corrections, jail | 02=released by or to courts | |||||||
| 08= Unknown - This code will continue to be accepted. However, states are encouraged to use the code 97 Unknown instead | 42=death of client | 06=death | |||||||
| 24=transferred to another treatment program or facility that is not in the state reporting system | 52=aged out; 62= other specified reasons | 05=extended placement; 09=reason not classified elsewhere | |||||||
| 34 =discharged from the state hospital to an acute medical facility for medical services (MH only) | |||||||||
| 96 = Not appliciable (MH only) | |||||||||
| 97=unknown | 08=discharged to an acute medical facility for medical services | ||||||||
| 98=not collected | |||||||||
| 72=reason unknown | 97=unknown | ||||||||
| Client Discharge Transaction Type - Key field | DIS 14 | DIS 28 | D=Discharge (SA client) E=Discharge (MH client) U=Data update (MH client) | 82=reason not collected | 98=not collected | ||||
| MH Diagnostic Code - one (ICD-10 Compatible) | xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx- | Not reported | |||||||
| MHA 1a | MHD 2a | 999.9997 unknown | |||||||
| 999.9998=not collected | Mental Health Diagnosis - one | C-17 | xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx---- | ||||||
| 999.9997=unknown | |||||||||
| MH Diagnostic Code - two (ICD-10 Compatible) | MHA 1b | MHD 2b | xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx-; | 999.9998=not collected | |||||
| Mental Health Diagnosis - two | C-18 | ||||||||
| 999.9997 unknown | xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx- | ||||||||
| 999.9998=not collected | 999.9996 no second diagnosis | ||||||||
| 999.9997=unknown | |||||||||
| MH Diagnostic Code - three (ICD-10 Compatible) | MHA 1c | MHD 2c | xxx.xxxx; xxx-----; xxx.----; xxx.x---; xxx.xx--; xxx.xxx- | 999.9998=not collected | |||||
| Mental Health Diagnosis - three | C-19 | ||||||||
| 999.9997 unknown | xxx.xxxx; xxx.xxx-; xxx.xx--; xxx.x---; xxx---- | ||||||||
| 999.9998=not collected | 999.9996 no third diagnosis | ||||||||
| 999.9997=unknown | |||||||||
| SMI/SED Status | MHA 2 | MHD 3 | 1=SMI | 999.9998=not collected | |||||
| 2=SED | SMI/SED Status | C-08 | |||||||
| 3=at risk for SED (optional) | 1=SMI | ||||||||
| 4=Not SMI/SED | 2=SED | ||||||||
| 7=unknown | 3=at risk for SED (optional) | ||||||||
| 8=not collected | 4=Not SMI/SED | ||||||||
| 7=unknown | |||||||||
| School Attendance Status | MHA 3 | MHD 4 | 1=Yes, client has attended school at any time in the past 3 months | 8=not collected | |||||
| 2=No, client has not attended school at any time in the past three months | School Attendance Status | C-24 | |||||||
| 6=not applicable ( non-school age) | 1=Yes, client has attended school at any time in the past 3 months | ||||||||
| 7=unknown | 2=No, client has not attended school at any time in the past three months | ||||||||
| 8=not collected | 6=not applicable | ||||||||
| 7=unknown | |||||||||
| SH-Legal Status at Admission | MHA 4 | 01=voluntary-self | 8=not collected | ||||||
| 02=voluntary-others (parents, guardians, etc) | State Hospital-Admission Legal Status | R-05 | |||||||
| 03=involuntary-civil | 01=voluntary-self | ||||||||
| 04=involuntary-criminal | 02=voluntary-others (parents, guardians, etc) | ||||||||
| 05=involuntary-juvenile justice | 03=involuntary-civil | ||||||||
| 06=involuntary-civil, sexual | 04=involuntary-criminaL | ||||||||
| 96=not applicable | 05=involuntary-juvenile justice | ||||||||
| 97=unknown | 06=involuntary-civil, sexual | ||||||||
| 98=not collected | |||||||||
| optional reporting | 97=unknown | ||||||||
| GAF/CGAS Score – Optional | MHA 5 | MHD 6 | 0-100 GAF/CGAS Score | 98=not collected | |||||
| 997 = Unknown | GAF/CGAS Score | O-02 | optional reporting | ||||||
| 998 = Not collected | 0-100 GAF/CGAS score | ||||||||
| 997=unknown | |||||||||
| Not reported | 998=not collected | ||||||||
| Not reported | SH-Discharge Sequence Number | R-02 | ## - chronological order of discharge events from the earliest (numbering starts at 1 per client) | ||||||
| Not reported | SH-Number of Days Elapsed Before State Hospital Readmission | R-04 | ### - calculated difference between the discharge date and next admission date | ||||||
| Competitive Employment - Update Flag | C-11 | 0=no update | |||||||
| 1=C-10 is an update | |||||||||
| Not reported | 8=unknown | ||||||||
| Residential Status - Update Flag | C-14 | 0=no update | |||||||
| 1=C13 is an update | |||||||||
| Not reported | 8=unknown | ||||||||
| One-service date flag | C-16 | 1=one service date | |||||||
| Not reported | 2=multiple service dates | ||||||||
| Not reported | Record Type | H-01 | H=header record | ||||||
| Not reported | File Type | H-03 | H-02 | P=production; T=test | |||||
| Not reported | Start of the reporting period | H-04 | H-03 | YYYYMM | |||||
| Not reported | End of the reporting period | H-05 | H-04 | YYYYMM | |||||
| Not reported | Client record count | H-06 | H-05 | ######## - total # of client records | |||||
| Optional Data Elements Report Flag | H-07 | 1=Yes, state is reporting some or all of the optional data elements | |||||||
| 2=No, state is not reporting any of the optional data elements | |||||||||
| Report Date: July 12, 2018 | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |