Form 3 Client Report

Summary of Changes from the Existing RSR Package (0915-0323)
Ryan White Services Report
Provider Form - General Information
Modification
•

Current questions:
o Within your organization/agency, identify the number of physicians, nurse practitioners, or physician assistants who obtained a
Drug Addiction Treatment Act of 2000 waiver to treat opioid use disorder with medication assisted treatment (MAT), [e.g.,
buprenorphine, naltrexone] specifically approved by the U.S. Food and Drug Administration.
o How many of the above physicians, nurse practitioners, or physician assistants prescribed MAT (e.g., buprenorphine,
naltrexone) for opioid use disorders in the reporting period?

•

Modify to:
o How many physicians, nurse practitioners, or physician assistants in your organization prescribed medications for opioid use
disorder (MOUD) [e.g., buprenorphine, naltrexone] for opioid use disorders during the reporting period?

Client Level Variables
Add
1

Final July 1, 2024

•

ID 15 ) MedicalInsuranceID Health Coverage – modify) - HRSA HAB proposes adding Medicare Advantage as a response option
to the client's healthcare coverage data element.

Combine and Modify
•

EthnicityID & RaceID – Proposed modification to race and ethnicity data element per OMB guideline Standards for Maintaining,
Collecting, and Presenting Federal Data on Race and Ethnicity announced on March 29, 2024.
o What is your race and/or ethnicity?
Select all that apply and enter additional details in the space below.
☐American Indian or Alaska Native
For example enter, Navajo Nation, Blackfeet Tribe Indian Reservation of Montana, Native Village of Barrow Inupiat
Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

☐Asian
For example enter, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

☐Black or African American
For Example enter, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

☐Hispanic or Latino
For example enter, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.
2

Final July 1, 2024

☐Middle Eastern or North African
For example enter, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

☐Native Hawaiian or Pacific Islander
For example enter, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

☐White
For example enter, English, German, Irish, Italian, Polish, Scottish, etc.

3

Final July 1, 2024

TABLE 3

Ryan White Services Report (RSR) Variables
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 0906-0039, and the expiration date is
12/31/2024. Public reporting burden for this collection of information is estimated to average 51 hours per response, including the time for
reviewing instructions, searching existing data sources, 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 HRSA
Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland 20857.
ID

Variable Name

Demographics

4

RSR Client-Level Data – Demographics

Definition

Required

Occurrence

EnrollmentStatusID

The client’s vital enrollment
status at the end of the
reporting period.

CM, OA

1 per client

BirthYear

Client’s year of birth.

All (including C&T)

1 per client

EthnicityID

This value should be on or
before all service date years
for the client.
Client’s ethnicity.

All (including C&T)

1 per client

RaceID/EthnicityID

Client’s race and/or
Ethnicity.

All (including C&T)

1-5 per client

GenderID

Client’s current gender
identity. This is the variable

All (including C&T)

1 per client

Final July 1, 2024

Allowed Values
EnrollmentStatusID:
• Active,
• Deceased
• Unknown
BirthYear:
yyyy

EthnicityID: - Combined with RaceID
• Hispanic/Latino/a, or Spanish origin
• Non-Hispanic/Latino(a),or Spanish origin
RaceID:
• White
• Black or African American
• Hispanic or Latino - Add
• Middle Eastern or North Africa - Add
• Asian
• Native Hawaiian/Pacific Islander
• American Indian or Alaska Native
GenderID:
• Male

ID

Variable Name

Transgender

14

5

Definition
that is used for the eUCI.

Client’s current transgender
status.

Required

All (including C&T)

Occurrence

To be completed
only if the
response is
“Transgender” in
Item #6
1 per client

PovertyLevelID

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

CM, OA

HousingStatusID

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

CM, OA or Housing
services

1 per client

HivAidsStatusID

Client’s HIV/AIDS status at
the end of the reporting
period. For HIV affected
clients for whom HIV/AIDS
status is not known, leave
this value blank.

CM, OA

1 per client

HivRiskFactorID

Client’s HIV/AIDS risk
factor. Report all that apply.

CM, OA (including
C&T)

1-7 per client

Final July 1, 2024

Allowed Values
• Female
• Transgender
• Unknown
•
•
•

Male-to-Female
Female-to-Male
Unknown

PovertyLevelID:
• Below 100% of the Federal poverty level
• 100 -138% of the Federal poverty level
• 139 - 200% of the Federal poverty level
• 201 – 250% of the Federal poverty level
• 250 – 400% of the Federal poverty level
• 401 – 500% of the Federal poverty level
• More than 500% of the Federal poverty
level
HousingStatusID:
• Stable/permanent
• Temporary
• Unstable
HivAidsStatusID:
• HIV negative
• HIV +, not AIDS
• HIV-positive, AIDS status unknown
• CDC-defined AIDS
• HIV indeterminate (infants <2 only)
HivRiskFactorID:
•
Male to Male Sexual Contact (MSM)
• Injection drug use (IDU)
• Hemophilia/coagulation disorder
• Heterosexual contact
• Receipt of blood transfusion, blood
components, or tissue
• Perinatal transmission

6

ID

Variable Name

15

MedicalInsuranceID
Health Coverage – modify

Final July 1, 2024

Definition
Client’s medical insurance.
Report all that apply.

Required
CM, OA, HI – ALL
Core Services
including C&T)

Occurrence
1-8 per client

Allowed Values
• Risk factor not reported or not identified
MedicalInsuranceID:
• Private – Employer
• Private - Individual
• Medicare
• Medicare Advantage - Add
• Medicaid, CHIP or other public plan
• VA, Tricare and other military health care
• IHS
• No Insurance/ uninsured
• Other plan

Client-Level Data – Core Medical Service Visits
ID

Variable Name

Core Medical Service Visits

1625*

2645*

7

ClientReportServiceVisit
s
ServiceID
Visits

ClientReportServiceDelivered
ServiceID
DeliveredID

Final July 1, 2024

Definition
The number of visits
received for each core
medical service during the
reporting period.

The service and service
delivered indicator (yes) for
each core medical or
support service received by
the client during the
reporting period.

Required

Occurrence

All
At least one core or
support entry per client

All
At least one core or
support entry per client

1-number of
visits per service
per client

0-1 per service
per client

Allowed Values
Item ID:
Core Medical Services:
ID 16: Outpatient ambulatory health services
ID 17: Oral health care
ID 18: Early intervention services (Parts A
and B)
ID 19: Home health care
ID 20: Home and community-based health
services
ID 21: Hospice services
ID 22: Mental health services
ID 23: Medical nutrition therapy
ID 24: Medical case Management (including
treatment adherence)
ID 25: Substance abuse services-outpatient
Visits:
1-365 (must be an integer)
Core Medical Services:
Item ID:
ID 26: Local AIDS Pharmaceutical
Assistance (APA, not ADAP)
ID 27: Health Insurance Program(HIP)
Support Services:
Item ID:
ID 28: Case management (non-medical)
services
ID 29: Child care services
ID 30: Developmental assessment/early
intervention services
ID 31: Emergency financial assistance
ID 32: Food bank/home-delivered meals
ID 33: Health education/risk reduction
ID 34: Housing services

ID

Variable Name

Definition

Required

Occurrence

Allowed Values
ID 35: Legal services
ID 36: Linguistic services
ID 37: Transportation services
ID 38: Outreach services
ID 39: Permanency planning
ID 40: Psychosocial support services
ID 41: Referral for health care/supportive
services
ID 42: Rehabilitation services
ID 43: Respite care
ID 44: Substance abuse services-residential
ID 45: Treatment adherence counseling
DeliveredID:
Yes/No - # of services delivered

*Element ID#s are listed consecutively according to the RSR Data Dictionary; the 2018 RSR Instruction Manual is pending update.

8

Final July 1, 2024

Client-Level Data – Clinical Information
ID

Variable Name

47

FirstAmbulatoryCareDate

48

49

ClientReportAmbulatoryService
ServiceDate

ClientReportCd4Test
Count
ServiceDate

Definition

Date of client’s first HIV
ambulatory health services
date at this provider
agency.
This value must be on or
before the last date of the
reporting period.
All the dates of the client’s
outpatient ambulatory
health services visits in this
provider’s HIV care setting
with a clinical care
provider during this
reporting period.
The service dates must be
within the reporting period.
Values indicating all CD4
counts and their dates for
this client during this
report period.

Client Level Data
Required

Occurrences

Clinical Information
OA

0-1 per client

FirstAmbulatoryServicesVisitDate:
mm,dd,yyyy

OA

0-number of
days in reporting
period per client

ServiceDate:
mm,dd,yyyy
Must be within the reporting period start and
end dates.

OA

0-number of
days in reporting
period per client

Count:
Integer

1-number of
days in reporting
period

Count:
Integer
Report undetectable values as the lower bound
of the test limit. If the lower bound is not
available, report 0.

The service dates must be
within the reporting period.
50

9

ClientReportViralLoadTe
st
Count
ServiceDate

Final July 1, 2024

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

Allowed Values

OA

ServiceDate:
mm,dd,yyyy
Must be within the reporting period start and
end dates.

ID

52

Variable Name

PrescribedHaartID

HousingStatusDateID

Definition

Client Level Data
Required

Occurrences

Clinical Information

Value indicating whether
OA
the client prescribed
HAART at any time during
this reporting period.
Value indicating date when housing
status is collected.

1 per client

OA

The service date must be within the
reporting period.

64

10

PregnantID

Final July 1, 2024

Value indicating whether the client
was pregnant during this reporting
period. This should be completed
for HIV+ women only.

OA
if the client is
an HIV+
female

Allowed Values
ServiceDate:
mm,dd,yyyy
Must be within the reporting period start and
end dates.
PrescribedHaartID:
• Yes
• No

0-number of
days in reporting
period per client

Count:
Integer

0-1 per client

PregnantID:
• No
• Yes
• Not applicable

ServiceDate:
mm,dd,yyyy
Must be within the reporting period start and
end dates.

ID

Variable Name

Demographics
68
HispanicSubgroupID

Definition

Client Level Data
Required

Occurrences

New Variables

If EthnicityID = Hispanic/Latino(a),
Client’s Hispanic Sub-group (choose
all that apply)

All (included
C&T)

0-4 per client

Allowed Values

Mexican, Mexican American, Chicano/a
Puerto Rican
Cuban
Another Hispanic, Latino/a or Spanish
origin
• Asian Indian
• Chinese
• Filipino
• Japanese
• Korean
• Vietnamese
• Other Asian
• Native Hawaiian
• Guamanian or Chamorro
• Samoan
• Other Pacific Islander
HIVDiagnosisYear:
yyyy
Must be less than or equal to the reporting
period year.
•
•
•
•

69

AsianSubgroupID

If RaceID = Asian, Client’s Asian
subgroup. (choose all that apply)

All (included
C&T)

0-7 per client

70

NHPISubgroupID

If RaceID=Native Hawaiian/Pacific
Islander, Client’s Native
Hawaiian/Pacific Islander
subgroup.(choose all that apply)

All (included
C&T)

0-4 per client

72

HIVDiagnosisYear

Year of client’s HIV diagnosis, if
known. To be completed for a new
client when the response is not
“HIV-negative” or HIV
indeterminate” in 12.

CM, OA
For a new client,
if the response is
not “HIVnegative” or HIV
indeterminate” in
12.

1 per client

The biological sex assigned to the
client at birth

All (included
C&T)

1 per client

1 = Male
2 = Female

Date of client’s confidential

All C&T clients

0-1 per client

HIV Positive Test Date:

This value must be on or before the
last date of the reporting period.
71

SexAtBirth ID

HIV Counseling and Testing
73
HIVPosTestDate

11

Final July 1, 2024

ID

Variable Name

Definition

Client Level Data
Required

confirmatory HIV test with a positive
result within the reporting period.

74

OAHSlinkDate

Date of client’s first OAMC medical
care visit after positive HIV test.
Date must be the same day or after
the date of client’s confidential
confirmatory HIV test with a positive
result.

12

Final July 1, 2024

Occurrences

New Variables

with confidential
positive HIV
confirmatory test
during the
reporting period
All C & T clients
with a
confidential
positive HIV
confirmatory test
during the
reporting period

Allowed Values
mm,dd,yyyy
Must be within the reporting period.

0-1 per client

HIV OAMC linkage date:
mm,dd,yyyy
Must be within the reporting period and on the
same day or later than HIV positive test date.