FHIR IG analytics| Package | us.co.bha-ig |
| Resource Type | Questionnaire |
| Id | Questionnaire-BHAAdmissionQuestionnaire.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/CoBHA/CoBHRM-FHIR-IG/Questionnaire-BHAAdmissionQuestionnaire.html |
| URL | http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire |
| Version | 0.3.0-current |
| Status | active |
| Date | 2025-12-13 |
| Name | BHAAdmissionQuestionnaire |
| Title | BHA Admission Questionnaire |
| Realm | us |
| Description | Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire BHAAdmissionQuestionnaire
Profile: SDC Base Questionnaire version: 4.0.0-ci-build
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  BHAAdmissionQuestionnaire | Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services | Questionnaire | http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire#0.3.0-current | |
  lastUpdated | Last Updated DateTime of the data in the QuestionnaireResponse | 1..1 | dateTime | |
 SERVICE_IDENTIFIER | Service Identifier | 1..1 | choice | Value Set: ValueSet for BHA Service Identifier Codes |
 FIRST_CONTACT_DATE | Date of First Contact | 1..1 | date | |
| FIRST_APPOINTMENT_OFFERED_DATE | Date of First Appointment Offered | 1..1 | date | |
 MEDICATION_ASSISTED_THERAPY | Medication Assisted Therapy | 1..1 | boolean | |
| REFERRAL_SOURCE | Referral Source | 1..1 | choice | Value Set: ValueSet for BHA Referral Source |
 ARRESTS_PAST_30_DAYS | Arrests in Past 30 Days | 1..1 | integer | |
| EMPLOYMENT_STATUS | Employment Status | 1..1 | choice | Value Set: ValueSet for BHA Employment Status |
| LIVING_SITUATION | Living Situation | 1..1 | choice | Value Set: ValueSet for BHA Living Situation |
 MONTHLY_INCOME | Monthly Income | 0..1 | decimal | |
| PRIMARY_INCOME_SOURCE | Primary Source of income/support for client (or for client's parent if client >18 years of age) | 1..1 | choice | Value Set: ValueSet for BHA Income Source |
| PREGNANCY_STATUS | Pregnancy Status | 1..1 | boolean | |
| WITHIN_1_YEAR_POSTPARTUM_STATUS | Within 1 Year Postpartum Status | 1..1 | boolean | |
| SPECIAL_CONNECTIONS_ENROLLMENT | Enrollment in Special Connections | 1..1 | boolean | |
| ACT_ENROLLMENT | Enrollment in ACT? | 1..1 | boolean | |
| ASCENT_ENROLLMENT | Enrollment in Ascent (FEP)? | 1..1 | boolean | |
| NUMBER_DEPENDENT_CHILDREN | Number of Dependent Children | 1..1 | integer | |
| SELF_HELP_ATTENDANCE | Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance | 1..1 | integer | |
| TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT | Substance Use Prior Treatment (Total Lifetime admissions) | 1..1 | integer | |
| PSYCHIATRIC_HOSPITAL_ADMISSION | Psychiatric Hospital Admission (Last 30 days) | 1..1 | boolean | |
| LEGAL_STATUS | Legal Status | 1..1 | choice | Value Set: ValueSet for BHA Legal Status |
| INVOLUNTARY_COMMITMENT_REASON | Involuntary Commitment Reason | 0..1 | choice | Enable When:
Value Set: ValueSet for BHA Involuntary Commitment Reason |
| CRIMINAL_JUSTICE_INVOLVEMENT | Criminal Justice Involvement | 0..1 | boolean | |
| EDUCATION_LEVEL | Education Level | 1..1 | choice | Value Set: ValueSet for BHA Education Level |
| SCHOOL_ATTENDANCE_STATUS | School Attendance Status (in the previous 3 months) | 1..1 | choice | Value Set: ValueSet for BHA School Attendance Status |
| PSYCHIATRIC_ER_VISIT_6_MONTHS | Visit to Psychiatric ER in last 6 months | 1..1 | integer | |
| COMMUNICATION_ACCOMMODATIONS | Communication Accommodations | 0..1 | boolean | |
 episodeOfCare | Episode of Care Information | 1..* | reference | |
 diagnosis | Diagnosis Information | 1..* | reference | |
| Documentation for this format | ||||
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "BHAAdmissionQuestionnaire",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|4.0.0-ci-build"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
"valueCoding": {
"system": "http://hl7.org/fhir/version-algorithm",
"code": "semver",
"display": "SemVer"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 1,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://bha.colorado.gov/fhir/bha-ig/ImplementationGuide/us.co.bha-ig"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://bha.colorado.gov/fhir/bha-ig/ImplementationGuide/us.co.bha-ig"
}
]
}
}
],
"url": "http://bha.colorado.gov/fhir/bha-ig/Questionnaire/BHAAdmissionQuestionnaire",
"version": "0.3.0-current",
"name": "BHAAdmissionQuestionnaire",
"title": "BHA Admission Questionnaire",
"status": "active",
"subjectType": [
"Patient"
],
"date": "2025-12-13",
"publisher": "Colorado Behavioral Health Administration",
"contact": [
{
"name": "Colorado Behavioral Health Administration",
"telecom": [
{
"system": "url",
"value": "https://bha.colorado.gov"
},
{
"system": "email",
"value": "FHIRFeedback@state.co.us"
}
]
}
],
"description": "Questionnaire used during admission process to collect demographic, social, clinical, and administrative information from patients entering behavioral health services",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "USA"
}
]
}
],
"item": [
{
"linkId": "lastUpdated",
"text": "Last Updated DateTime of the data in the QuestionnaireResponse",
"type": "dateTime",
"required": true
},
{
"linkId": "SERVICE_IDENTIFIER",
"text": "Service Identifier",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-service-identifier-vs"
},
{
"linkId": "FIRST_CONTACT_DATE",
"text": "Date of First Contact",
"type": "date",
"required": true
},
{
"linkId": "FIRST_APPOINTMENT_OFFERED_DATE",
"text": "Date of First Appointment Offered",
"type": "date",
"required": true
},
{
"linkId": "MEDICATION_ASSISTED_THERAPY",
"text": "Medication Assisted Therapy",
"type": "boolean",
"required": true
},
{
"linkId": "REFERRAL_SOURCE",
"text": "Referral Source",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-referral-source-vs"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 30
}
],
"linkId": "ARRESTS_PAST_30_DAYS",
"text": "Arrests in Past 30 Days",
"type": "integer",
"required": true
},
{
"linkId": "EMPLOYMENT_STATUS",
"text": "Employment Status",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-employment-status-vs"
},
{
"linkId": "LIVING_SITUATION",
"text": "Living Situation",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-living-situation-vs"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueDecimal": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueDecimal": 9999
}
],
"linkId": "MONTHLY_INCOME",
"text": "Monthly Income",
"type": "decimal",
"required": false
},
{
"linkId": "PRIMARY_INCOME_SOURCE",
"text": "Primary Source of income/support for client (or for client's parent if client >18 years of age)",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-income-source-vs"
},
{
"linkId": "PREGNANCY_STATUS",
"text": "Pregnancy Status",
"type": "boolean",
"required": true
},
{
"linkId": "WITHIN_1_YEAR_POSTPARTUM_STATUS",
"text": "Within 1 Year Postpartum Status",
"type": "boolean",
"required": true
},
{
"linkId": "SPECIAL_CONNECTIONS_ENROLLMENT",
"text": "Enrollment in Special Connections",
"type": "boolean",
"required": true
},
{
"linkId": "ACT_ENROLLMENT",
"text": "Enrollment in ACT?",
"type": "boolean",
"required": true
},
{
"linkId": "ASCENT_ENROLLMENT",
"text": "Enrollment in Ascent (FEP)?",
"type": "boolean",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 99
}
],
"linkId": "NUMBER_DEPENDENT_CHILDREN",
"text": "Number of Dependent Children",
"type": "integer",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 30
}
],
"linkId": "SELF_HELP_ATTENDANCE",
"text": "Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance",
"type": "integer",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 30
}
],
"linkId": "TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT",
"text": "Substance Use Prior Treatment (Total Lifetime admissions)",
"type": "integer",
"required": true
},
{
"linkId": "PSYCHIATRIC_HOSPITAL_ADMISSION",
"text": "Psychiatric Hospital Admission (Last 30 days)",
"type": "boolean",
"required": true
},
{
"linkId": "LEGAL_STATUS",
"text": "Legal Status",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-legal-status-vs"
},
{
"linkId": "INVOLUNTARY_COMMITMENT_REASON",
"text": "Involuntary Commitment Reason",
"type": "choice",
"enableWhen": [
{
"question": "LEGAL_STATUS",
"operator": "=",
"answerCoding": {
"system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-legal-status",
"code": "04",
"display": "72-hour evaluation and treatment"
}
},
{
"question": "LEGAL_STATUS",
"operator": "=",
"answerCoding": {
"system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-legal-status",
"code": "05",
"display": "Short-term certification"
}
},
{
"question": "LEGAL_STATUS",
"operator": "=",
"answerCoding": {
"system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-legal-status",
"code": "06",
"display": "Long-term certification"
}
},
{
"question": "LEGAL_STATUS",
"operator": "=",
"answerCoding": {
"system": "http://bha.colorado.gov/fhir/bha-ig/CodeSystem/bha-legal-status",
"code": "09",
"display": "Emergency/Involuntary Alcohol/Drug Commitment"
}
}
],
"enableBehavior": "any",
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-involuntary-commitment-reason-vs"
},
{
"linkId": "CRIMINAL_JUSTICE_INVOLVEMENT",
"text": "Criminal Justice Involvement",
"type": "boolean",
"required": false
},
{
"linkId": "EDUCATION_LEVEL",
"text": "Education Level",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-education-level-vs"
},
{
"linkId": "SCHOOL_ATTENDANCE_STATUS",
"text": "School Attendance Status (in the previous 3 months)",
"type": "choice",
"required": true,
"answerValueSet": "http://bha.colorado.gov/fhir/bha-ig/ValueSet/bha-school-attendance-status-vs"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 99
}
],
"linkId": "PSYCHIATRIC_ER_VISIT_6_MONTHS",
"text": "Visit to Psychiatric ER in last 6 months",
"type": "integer",
"required": true
},
{
"linkId": "COMMUNICATION_ACCOMMODATIONS",
"text": "Communication Accommodations",
"type": "boolean",
"required": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode": "EpisodeOfCare"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
"valueCanonical": "http://bha.colorado.gov/fhir/bha-ig/StructureDefinition/bha-episodeOfCare"
}
],
"linkId": "episodeOfCare",
"text": "Episode of Care Information",
"type": "reference",
"required": true,
"repeats": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode": "Condition"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
"valueCanonical": "http://bha.colorado.gov/fhir/bha-ig/StructureDefinition/BHAEpisodeDiagnosis"
}
],
"linkId": "diagnosis",
"text": "Diagnosis Information",
"type": "reference",
"required": true,
"repeats": true
}
]
}