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OMB No. 0930-0335 |
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Expiration Date: XX/XX/XXXX |
| 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 XX 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-A, Rockville, Maryland, 20857. |
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| 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. |
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| MH-CLD |
| Variable Name |
Data Field Reference No. |
Categories |
| Data Files |
| BCI |
SHR |
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| Record Type |
H-01 |
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H=Header Record |
| Reporting State Code |
H-02 |
H-01 |
2 Character State Abbreviation |
| File Type |
H-03 |
H-02 |
P=Production |
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T=Test |
| Start of the Report Period |
H-04 |
H-03 |
YYYYMM - The numeric format for months 1-9 must have a zero as the leading digit. |
| End of the Report Period |
H-05 |
H-04 |
YYYYMM - The numeric format for months 1-9 must have a zero as the leading digit. |
| Client Record Count |
H-06 |
H-05 |
######## - Up to 8 digits |
| Optional Data Elements Report Flag |
H-07 |
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1=Yes |
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2=No |
| Diagnostic Code Identifier |
H-08 |
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1=DSM-IV |
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2=ICD-9 |
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3=ICD 10 |
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4=DSM-5 |
| This information is contained in the file name algorithm |
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MMDDYYYY |
| Transaction Type |
C-00 |
R-00 |
A=Add |
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C=Change |
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D=Delete |
| Client Identifier |
C-01 |
R-01 |
1-15 Alphanumeric Characters (XXXXXXXXXXXXXXX - if the states unique ID is fewer than 15 characters, fill the gap with blank spaces) |
| Client Treatment Status at the Start of the Reporting Period |
C-02 |
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1=New Client |
| 2=Continuing Client |
| Client Treatment Status at end of the reporting period |
C-03 |
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01=Continuing Client |
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12=Discharged with Treatment Completed |
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22=Discharged Due to Lost Contact/ Administrative Discharge |
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32=Discharged to Corrections, Jail |
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42=Discharged Due to Death of Client |
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52=Aged out |
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62=Discharged Due To Other Specified Reasons |
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72=Discharged, Reason Unknown |
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82=Discharged, Reason Not Collected |
| Sex |
C-04 |
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1=Male |
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2=Female |
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7=Unknown |
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8=Not Collected |
| Age |
C-05 |
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0-85=Any Number up to 85 |
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97=Unknown |
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98=Not Collected |
| Race |
C-06 |
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02=American Indian or Alaska Native |
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03=Asian or Pacific Islander (Temporary code) |
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13=Asian |
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23=Native Hawaiian or Other Pacific Islander |
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04= Black or African American |
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05=White |
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20=Some Other Race Alone |
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21=Two or More Races |
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22=Hispanic |
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97=Unknown |
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98=Not Collected |
| Ethnicity |
C-07 |
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01=Hispanic Origin Regardless of Race |
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11=Puerto Rican (Optional) |
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12=Mexican (Optional) |
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13=Cuban (Optional) |
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14=Other Specific Hispanic (Optional) |
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02=Not of Hispanic Origin |
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97=Unknown |
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98=Not Collected |
| SMI/SED Status |
C-08 |
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1=SMI |
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2=SED |
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3=At Risk for SED (Optional) |
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4=Not SMI or SED |
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7=Unknown |
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8=Not Collected |
| Competitive Employment Status (Aged 16+) – at Admission or Start of the Reporting Period |
C-09 |
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01=Full Time |
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02=Part Time |
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03=Unemployed |
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05=Employed - Full Time/Part Time Not Differentiated (Temporary Code) |
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14=Homemaker |
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24=Student |
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34=Retired |
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44=Disabled |
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64=Other Reported Classification |
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74=Sheltered/Non-Competitive Employment |
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84=Not in the Labor Force, Classification not Specified (Temporary Code) |
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96=Not Applicable |
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97=Unknown |
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98=Not Collected |
| Competitive Employment Status (Aged 16+) – at Discharge or End of the Reporting Period |
C-10 |
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01=Full Time |
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02=Part Time |
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03=Unemployed |
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05=Employed - Full time/Part Time not Differentiated (Temporary Code) |
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14=Homemaker |
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24=Student |
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34=Retired |
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44=Disabled |
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64=Other Reported Classification |
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74=Sheltered/Non-Competitive Employment |
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84=Not in the Labor Force, Classification not Specified (Temporary Code) |
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96=Not Applicable |
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97=Unknown |
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98=Not Collected |
| Competitive Employment Status Update Flag |
C-11 |
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0=Data Reported in C-10 is Not an Update for Data Reported in C-09 |
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1=Data Reported in C-10 is an Update for Data Reported in C-09 |
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8=Update Status Unknown |
| Residential Status – at Admission or Start of the Reporting Period |
C-12 |
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01=Homeless |
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02=Foster Home/Foster Care |
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03=Residential Care |
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04=Crisis Residence |
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05=Institutional Setting |
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06=Jail/Correctional Facility/Other Institutions under the Justice System |
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07=Private Residence - Living Arrangement not Known (for adult use only) |
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17=Private Residence - Independent Living (for adult use only) |
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27=Private Residence - Dependent Living (for adult use only) |
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37=Private Residence (for children use only) |
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08=Other Residential Status |
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97=Unknown |
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98=Not Collected |
| Residential Status – at Discharge or End of Reporting Period |
C-13 |
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01=Homeless |
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02=Foster Home/Foster Care |
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03=Residential Care |
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04=Crisis Residence |
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05=Institutional Setting |
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06=Jail/Correctional Facility/Other Institutions under the Justice System |
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07=Private Residence - Living Arrangement not Known (for adult use only) |
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17=Private Residence - Independent Living (for adult use only) |
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27=Private Residence - Dependent Living (for adult use only) |
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37=Private Residence (for children use only) |
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08=Other Residential Status |
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97=Unknown |
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98=Not Collected |
| Residential Status Update Flag |
C-14 |
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0=Data Reported in C-13 is Not an Update for Data Reported in C-12 |
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1=Data Reported in C-13 is an Update for Data Reported in C-12 |
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8=Update Status Unknown |
| Service Setting Status Throughout the Reporting Period |
C-15 |
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1=State Psychiatric Hospital |
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2=SMHA-Funded/Operated Community-Based Program |
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3=Residential Treatment Center |
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4=Other Psychiatric Inpatient |
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5=Institutions under the Justice System |
| One Service Date Flag |
C-16 |
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1=One Service Date |
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2=Multiple Service Dates |
| Mental Health Diagnosis - one |
C-17 |
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XXX.XXXX=DSM-IV, DSM-5, ICD-9 or ICD-10 Mental Health Diagnosis Code |
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999.9997=Unknown |
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999.9998=Not collected |
| Mental Health Diagnosis - Two |
C-18 |
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XXX.XXXX=DSM-IV, DSM-5, ICD-9 or ICD-10 Mental Health Diagnosis Code |
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999.9996=No Second Diagnosis |
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999.9997=Unknown |
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999.9998=Not Collected |
| Mental Health Diagnosis - Three |
C-19 |
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XXX.XXXX=DSM-IV, DSM-5, ICD-9 or ICD-10 Mental Health Diagnosis Code |
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999.9996=No Third Diagnosis |
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999.9997=Unknown |
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999.9998=Not Collected |
| Substance Use Diagnosis |
C-20 |
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XXX.XXXX=DSM-IV, DSM-5, ICD-9 or ICD-10 Substance Use Diagnosis Code |
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999.9996=No Substance Use Diagnosis |
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999.9997=Unknown |
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999.9998=Not Collected |
| Substance Use Disorder |
C-21 |
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1=Yes |
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2=No |
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7=Unknown |
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8=Not collected |
| Number of Arrests in Prior 30 Days – at Admission or Start of the Reporting Period |
C-22 |
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00-96=Any Number up to 96 |
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97=Unknown |
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98=Not Collected |
| Number of Arrests in Prior 30 Days – at Discharge or End of the Reporting Period |
C-23 |
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00-96=Any Number up to 96 |
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97=Unknown |
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98=Not Collected |
| School Attendance Status – at Discharge or End of the Reporting Period |
C-24 |
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1=Yes, client has attended school at any time in the past 3 months |
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2=No, client has not attended school at any time in the in the past 3 months |
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6=Not Applicable |
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7=Unknown |
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8=Not Collected |
| School Grade Level |
C-25 |
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00=No Years of Schooling |
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01-12=Grades 1 through 12 |
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13=Nursery School, Preschool (Inlcuding Head Start) |
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14=Kindergarten |
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15=Self-contained Special Education Class (No Equivalent Grade Level) |
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16=Vocational School |
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17=College Undergraduate Freshman (1st Year) |
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18=College Undergraduate Sophomore (2nd Year) |
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19=College Undergraduate Junior (3rd Year) |
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20=College Undergraduate Senior (4th year) or Bachelor’s Degree |
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21=Graduate or Professional School (e.g., Master's, Doctoral, Medical, or Law School) |
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97 = Unknown |
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98=Not Collected |
| School Attendance Status – at Admission or Start of the Reporting Period |
C-26 |
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1=Yes, client has attended school at any time in the past 3 months |
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2=No, client has not attended school at any time in the in the past 3 months |
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6=Not Applicable |
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7=Unknown |
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8=Not Collected |
| Gender Identity (Optional Reporting) |
O-01 |
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01=Male |
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02=Female |
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03=Transgender (Male to Female) |
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13=Transgender (Female to Male) |
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23=Transgender [Temporary code] |
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04=Two-Spirit [American Indian or Alaska Native only] |
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06=Other |
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16=I don't know |
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26=Prefer not to answer |
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97=Unknown |
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98=Not Collected |
| Sexual Orientation (Optional Reporting) |
O-02 |
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01=Straight or Heterosexual |
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02=Lesbian or Gay |
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03=Bisexual |
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04=Two-Spirit [American Indian or Alaska Native only] |
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06=Other |
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16=I don't know |
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26=Prefer not to answer |
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97=Unknown |
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98=Not Collected |
| Marital Status (Optional Reporting) |
O-03 |
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01=Never Married |
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02=Married/Living as Couple |
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03=Separated |
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04=Divorced |
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05=Widowed |
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97=Unknown |
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98=Not Collected |
| Global Assessment of Functioning (Adults)/Children's Global Assessment Scale (Optional Reporting) |
O-04 |
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0-100 GAF/CGAS Score |
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997=Unknown |
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998=Not Collected |
| Type of Funding Support (Optional Reporting) |
O-05 |
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01=Medicaid Only |
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02=Medicaid and Non-Medicaid Sources |
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03=Non-Medicaid Only |
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97=Unknown |
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98=Not Collected |
| Mental Health Block Grant-Funded Services (Optional Reporting) |
O-06 |
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01=Yes, MHBG Used to Pay for Services & Supports |
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02=No, MHBG Funds Were Not Used |
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97=Unknown |
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98=Not Collected |
| Veteran Status (Optional Reporting) |
O-07 |
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1=Veteran |
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2=Not a Veteran |
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7=Unknown |
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8=Not Collected |
| SH-Discharge Sequence Number |
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R-02 |
## - chronological order of discharge events from the earliest (numbering starts at 1 per client) |
| SH-Discharge Reason |
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R-03 |
01=Completed State Hospital Inpatient Treatment |
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02=Released by or to Courts |
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03=Left Against Medical Advice/Eloped or Failed to Return from Leave/Non-Compliance with Treatment and/or Policy |
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04=Client Choice |
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05=Extended Placement |
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06=Death |
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07=Discharged to Other Inpatient Provider |
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08=Discharged to an Acute Medical Facility for Medical Services |
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09=Discharged, Reason not Classified Elsewhere |
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97=Unknown |
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98=Not Collected |
| SH-Number of Days Elapsed Before State Hospital Readmission |
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R-04 |
### - calculated difference between the discharge date and next admission date |
| 998 = If readmission event did not occur after a discharge event |
| State Hospital-Admission Legal Status |
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R-05 |
01=Voluntary - Self |
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02=Voluntary - Others (by Guardian, Parents, etc.) |
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03=Involuntary - Civil |
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04=Involuntary - Criminal |
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05=Involuntary - Juvenile Justice |
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06=Involuntary - Civil - Sexual |
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97=Unknown |
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98=Not Collected |