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Packagebha-ig
Resource TypeQuestionnaireResponse
IdQuestionnaireResponse-BHAAdmissionQuestionnaireResponseExample.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: QuestionnaireResponse BHAAdmissionQuestionnaireResponseExample

LinkIDTextDefinitionAnswerdoco
.. BHAAdmissionQuestionnaireResponseExampleQuestionnaire:BHA Admission Questionnaire
... FIRST_CONTACT_DATEDate of First Contact2025-07-01
... FIRST_APPOINTMENT_OFFERED_DATEDate of First Appointment Offered2025-07-15
... MEDICATION_ASSISTED_OPIOID_THERAPYMedication Assisted Opioid Therapytrue
... REFERRAL_SOURCEReferral SourceBHA Referral Source: 1 (Individual (self, family, friend))
... ARRESTS_PAST_30_DAYSArrests in Past 30 Days1
... EMPLOYMENT_STATUSEmployment StatusBHA Employment Status: 01 (Employed Full Time (35+ hours/week))
... MARITAL_STATUSMarital StatusBHA Marital Status: 01 (Never Married)
... LIVING_SITUATIONLiving SituationBHA Living Situation: 1 (Correctional facility / Jail)
... MONTHLY_INCOMEMonthly Income999
... PRIMARY_INCOME_SOURCEPrimary Source of income/support for client (or for client's parent if client >18 years of age)BHA Income Source: 2 (Public Assistance)
... PREGNANCY_STATUSPregnancy Statusfalse
... WITHIN_1_YEAR_POSTPARTUM_STATUSWithin 1 Year Postpartum Statusfalse
... SPECIAL_CONNECTIONS_ENROLLMENTEnrollment in Special Connectionsfalse
... ACT_ENROLLMENTEnrollment in ACT?false
... ASCENT_ENROLLMENTEnrollment in Ascent (FEP)?false
... NUMBER_DEPENDENT_CHILDRENNumber of Dependent Children0
... SELF_HELP_ATTENDANCESelf Help Attendance (Last 30 days at admission)/ Peer Support Attendance0
... TOTAL_SUBSTANCE_USE_PRIOR_TREATMENTSubstance Use Prior Treatment (Total Lifetime admissions)9
... PSYCHIATRIC_HOSPITAL_ADMISSIONPsychiatric Hospital Admission (Last 30 days)true
... LEGAL_STATUSLegal StatusBHA Legal Status: 02 (Court-directed voluntary)
... CRIMINAL_JUSTICE_INVOLVEMENTCriminal Justice Involvementfalse
... EDUCATION_LEVELEducation LevelBHA Education Level: 14 (Some College)
... SCHOOL_ATTENDANCE_STATUSSchool Attendance Status (in the previous 3 months)BHA School Attendance Status: 03 (Not Applicable)
... PSYCHIATRIC_ER_VISIT_6_MONTHSVisit to Psychiatric ER in last 6 months0
... COMMUNICATION_ACCOMMODATIONSCommunication Accommodationstrue

doco Documentation for this format

Source1

{
  "resourceType": "QuestionnaireResponse",
  "id": "BHAAdmissionQuestionnaireResponseExample",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "questionnaire": "http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire",
  "status": "completed",
  "subject": {
    "reference": "Patient/example",
    "display": "Mickey Mouse"
  },
  "authored": "2025-10-28T18:30:40-07:00",
  "item": [
    {
      "linkId": "FIRST_CONTACT_DATE",
      "text": "Date of First Contact",
      "answer": [
        {
          "valueDate": "2025-07-01"
        }
      ]
    },
    {
      "linkId": "FIRST_APPOINTMENT_OFFERED_DATE",
      "text": "Date of First Appointment Offered",
      "answer": [
        {
          "valueDate": "2025-07-15"
        }
      ]
    },
    {
      "linkId": "MEDICATION_ASSISTED_OPIOID_THERAPY",
      "text": "Medication Assisted Opioid Therapy",
      "answer": [
        {
          "valueBoolean": true
        }
      ]
    },
    {
      "linkId": "REFERRAL_SOURCE",
      "text": "Referral Source",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-referral-source",
            "code": "1"
          }
        }
      ]
    },
    {
      "linkId": "ARRESTS_PAST_30_DAYS",
      "text": "Arrests in Past 30 Days",
      "answer": [
        {
          "valueInteger": 1
        }
      ]
    },
    {
      "linkId": "EMPLOYMENT_STATUS",
      "text": "Employment Status",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-employment-status-cs",
            "code": "01"
          }
        }
      ]
    },
    {
      "linkId": "MARITAL_STATUS",
      "text": "Marital Status",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-marital-status",
            "code": "01"
          }
        }
      ]
    },
    {
      "linkId": "LIVING_SITUATION",
      "text": "Living Situation",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-living-situation",
            "code": "1"
          }
        }
      ]
    },
    {
      "linkId": "MONTHLY_INCOME",
      "text": "Monthly Income",
      "answer": [
        {
          "valueDecimal": 999
        }
      ]
    },
    {
      "linkId": "PRIMARY_INCOME_SOURCE",
      "text": "Primary Source of income/support for client (or for client's parent if client >18 years of age)",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-income-source",
            "code": "2"
          }
        }
      ]
    },
    {
      "linkId": "PREGNANCY_STATUS",
      "text": "Pregnancy Status",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "WITHIN_1_YEAR_POSTPARTUM_STATUS",
      "text": "Within 1 Year Postpartum Status",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "SPECIAL_CONNECTIONS_ENROLLMENT",
      "text": "Enrollment in Special Connections",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "ACT_ENROLLMENT",
      "text": "Enrollment in ACT?",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "ASCENT_ENROLLMENT",
      "text": "Enrollment in Ascent (FEP)?",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "NUMBER_DEPENDENT_CHILDREN",
      "text": "Number of Dependent Children",
      "answer": [
        {
          "valueInteger": 0
        }
      ]
    },
    {
      "linkId": "SELF_HELP_ATTENDANCE",
      "text": "Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance",
      "answer": [
        {
          "valueInteger": 0
        }
      ]
    },
    {
      "linkId": "TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT",
      "text": "Substance Use Prior Treatment (Total Lifetime admissions)",
      "answer": [
        {
          "valueInteger": 9
        }
      ]
    },
    {
      "linkId": "PSYCHIATRIC_HOSPITAL_ADMISSION",
      "text": "Psychiatric Hospital Admission (Last 30 days)",
      "answer": [
        {
          "valueBoolean": true
        }
      ]
    },
    {
      "linkId": "LEGAL_STATUS",
      "text": "Legal Status",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-legal-status",
            "code": "02"
          }
        }
      ]
    },
    {
      "linkId": "CRIMINAL_JUSTICE_INVOLVEMENT",
      "text": "Criminal Justice Involvement",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "EDUCATION_LEVEL",
      "text": "Education Level",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-education-level-cs",
            "code": "14"
          }
        }
      ]
    },
    {
      "linkId": "SCHOOL_ATTENDANCE_STATUS",
      "text": "School Attendance Status (in the previous 3 months)",
      "answer": [
        {
          "valueCoding": {
            "system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-school-attendance-status",
            "code": "03"
          }
        }
      ]
    },
    {
      "linkId": "PSYCHIATRIC_ER_VISIT_6_MONTHS",
      "text": "Visit to Psychiatric ER in last 6 months",
      "answer": [
        {
          "valueInteger": 0
        }
      ]
    },
    {
      "linkId": "COMMUNICATION_ACCOMMODATIONS",
      "text": "Communication Accommodations",
      "answer": [
        {
          "valueBoolean": true
        }
      ]
    }
  ]
}