FHIR Implementation Guide for NJSAMS


1.0.0 - release

NJSAMS - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: Addiction Severity Index Questionnaire

Official URL: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/ASIQuestionnaire Version: 1.0.0
Draft as of 2022-08-31 Computable Name:

Generated Narrative: Questionnaire ASIQuestionnaire

LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. Questionnairehttps://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/ASIQuestionnaire#1.0.0
... tblASIMedicalStatusnull0..1group
.... tblASIMedicalStatus.M1How many times in your life have you been hospitalized for medical problems0..1integer
.... tblASIMedicalStatus.M2YearsHow long ago was your last hospitalization for a physical problem0..1integer
.... tblASIMedicalStatus.M3Do you have any chronic medical problems which continue to interfere with your life?0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIMedicalStatus.M3SpecifyIf yes, specify (chronic medical problem)0..1text
.... tblASIMedicalStatus.M4Are you taking any prescribed medication on a regular basis for a physical problem?0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIMedicalStatus.M5Do you receive a pension for a physical disability0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIMedicalStatus.M5SpecifyIf yes, specify (pension for physica disability)0..1text
.... tblASIMedicalStatus.M6How many days have you experienced medical problems in the past 30 days1..1integer
.... tblASIMedicalStatus.M7How troubled or bothered have you been by these medical problems in the past 30 days1..1open-choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIMedicalStatus.M8How important to you now is treatment for these medical problems1..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIMedicalStatus.M9How would you rate the patient’s need for medical treatment0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASIMedicalStatus.M10Is the above information significantly distorted by: Patient’s misrepresentation0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIMedicalStatus.M11Is the above information significantly distorted by: Patient’s inability to understand0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIMedicalStatus.MCommentsComments (Medical status)0..1text
... tblASIEmploymentStatusnull0..1group
.... tblASIEmploymentStatus.E1YearsEducation completed (Year)0..1integer
.... tblASIEmploymentStatus.E1MonthsEducation completed (Months)0..1integer
.... tblASIEmploymentStatus.E2Training or technical education completed0..1integer
.... tblASIEmploymentStatus.E3Do you have a profession, trade or skill0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.E3SpecifyIf yes, specify (profession, trade or skill)0..1text
.... tblASIEmploymentStatus.E4Do you have a valid driver’s license1..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.E5Do you have an automobile available for use1..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.E6YearsHow long was your longest full-time job: years0..1integer
.... tblASIEmploymentStatus.E6MonthsHow long was your longest full-time job: months0..1integer
.... tblASIEmploymentStatus.E7Usual (or last) occupation0..1text
.... tblASIEmploymentStatus.E8Does someone contribute to your support in any way0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.E9Does this constitute the majority of your support0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.E12How much money did you receive from the following sources in the past 30 days: Employment (net income)0..1integer
.... tblASIEmploymentStatus.E13How much money did you receive from the following sources in the past 30 days: Unemployment compensation0..1integer
.... tblASIEmploymentStatus.E14How much money did you receive from the following sources in the past 30 days: DPA0..1integer
.... tblASIEmploymentStatus.E15How much money did you receive from the following sources in the past 30 days: Pension, benefits or social security0..1integer
.... tblASIEmploymentStatus.E16How much money did you receive from the following sources in the past 30 days: Mate, family or friends (Money for personal expenses)0..1integer
.... tblASIEmploymentStatus.E17How much money did you receive from the following sources in the past 30 days: Illegal0..1integer
.... tblASIEmploymentStatus.E10Usual employment pattern past 3 years0..1choiceValue Set: NJSAMS ASI Employment Status
.... tblASIEmploymentStatus.E11How many days were you paid for working in the past 30 days?1..1integer
.... tblASIEmploymentStatus.E18How many people depend on you for the majority of their food, shelter, etc.0..1integer
.... tblASIEmploymentStatus.E19How many days have you experienced employment problems in the past 30 days0..1integer
.... tblASIEmploymentStatus.E20How troubled or bothered have you been by these employment problems in the past 30 days0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIEmploymentStatus.E21How important to you now is counseling for these employment problems0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIEmploymentStatus.E22How would you rate the patient’s need for employment counseling0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASIEmploymentStatus.E23Is the above information significantly distorted by: Patient’s misrepresentation0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.E24Is the above information significantly distorted by: Patient’s inability to understand0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIEmploymentStatus.ECommentsEmployement / Suport status Comments0..1text
... tblASIDrugAlcoholStatusnull0..1group
.... tblASIDrugAlcoholStatus.D1DaysAlcohol-Any use at all: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D1YearsAlcohol-Any use at all: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D1RouteAlcohol-Any use at all: Route of Administration0..1choiceValue Set: NJSAMS ASI Oral Route of Administration
.... tblASIDrugAlcoholStatus.D2DaysAlcohol-To Intoxication: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D2YearsAlcohol-To Intoxication: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D2RouteAlcohol-To Intoxication: Route of Administration0..1choiceValue Set: NJSAMS ASI Oral Route of Administration
.... tblASIDrugAlcoholStatus.D3DaysHeroin: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D3YearsHeroin:Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D3RouteHeroin: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D4DaysMethadone: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D4YearsMethadone: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D4RouteMethadone: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D5DaysOther opiates/analgesics: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D5YearsOther opiates/analgesics: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D5RouteOther opiates/analgesics: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D6DaysBarbiturates: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D6YearsBarbiturates: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D6RouteBarbiturates: Lifetime Use0..1open-choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D7DaysOther sed/hyp/tranq.: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D7YearsOther sed/hyp/tranq.: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D7RouteOther sed/hyp/tranq.: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D8DaysCocaine: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D8YearsCocaine: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D8RouteCocaine: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D9DaysAmphetamines: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D9YearsAmphetamines: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D9RouteAmphetamines: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D10DaysMarijuana: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D10YearsMarijuana: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D10RouteMarijuana: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D11DaysHallucinogens: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D11YearsHallucinogens:Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D11RouteHallucinogens: Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D12DaysInhalants:Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D12YearsInhalants: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D12RouteInhalants:Route of Administration0..1choiceValue Set: NJSAMS ASI Route Of Administration
.... tblASIDrugAlcoholStatus.D13DaysMore than one substance per day [incl. alcohol]: Past 30 Days0..1integer
.... tblASIDrugAlcoholStatus.D13YearsMore than one substance per day [incl. alcohol]: Lifetime Use0..1integer
.... tblASIDrugAlcoholStatus.D14Which substance is the major problem0..1choiceValue Set: NJSAMS ASI Substances
.... tblASIDrugAlcoholStatus.D15How long was your last period of voluntary abstinence from this major substance?0..1integer
.... tblASIDrugAlcoholStatus.D16How many months ago did this abstinence end?0..1integer
.... tblASIDrugAlcoholStatus.D17How many times have you: Had alcohol delirium tremens:0..1integer
.... tblASIDrugAlcoholStatus.D18How many times have you: Overdosed on drugs0..1integer
.... tblASIDrugAlcoholStatus.D19How many times in your life have you been treated for: Alcohol Abuse0..1integer
.... tblASIDrugAlcoholStatus.D20How many times in your life have you been treated for: Drug Abuse0..1integer
.... tblASIDrugAlcoholStatus.D21How many of these were detox only: Alcohol0..1integer
.... tblASIDrugAlcoholStatus.D22How many of these were detox only: Drug0..1integer
.... tblASIDrugAlcoholStatus.D23How much money would you say you spent during the past 30 days on: Alcohol0..1integer
.... tblASIDrugAlcoholStatus.D24How much money would you say you spent during the past 30 days on: Drug0..1integer
.... tblASIDrugAlcoholStatus.D25How many days have you been treated in an outpatient setting for a alcohol or drugs in the past 30 days [Include NA,AA]?0..1integer
.... tblASIDrugAlcoholStatus.D26In the past 30 days, How many days have you experienced: Alcohol Problems0..1integer
.... tblASIDrugAlcoholStatus.D27In the past 30 days, How many days have you experienced: Drug Problems0..1integer
.... tblASIDrugAlcoholStatus.D28How troubled or bothered have you been in the past 30 days by these: Alcohol Problems0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIDrugAlcoholStatus.D29How troubled or bothered have you been in the past 30 days by these: Drug problems0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIDrugAlcoholStatus.D30How important to you now is treatment for these: Alcohol problems0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIDrugAlcoholStatus.D31How important to you now is treatment for these: Drug problems0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIDrugAlcoholStatus.D32How would you rate the patients need for treatment?: Alcohol problems0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASIDrugAlcoholStatus.D33How would you rate the patients need for treatment?: Drug Abuse0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASIDrugAlcoholStatus.D34Is the above information significantly distorted by: Patient's misrepresentation0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIDrugAlcoholStatus.D35Is the above information significantly distorted by: Patient's inability to understand0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIDrugAlcoholStatus.DCommentsComments0..1text
... tblASILegalStatusnull0..1group
.... tblASILegalStatus.L1Was this admission prompted or suggested by the criminal justice system (judge, probation/parole officer, etc.)0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASILegalStatus.L2Are you on probation or parole0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASILegalStatus.L3How many times in your life have you been arrested and charged with Shoplifting?0..1integer
.... tblASILegalStatus.L4How many times in your life have you been arrested and charged with Parole/Probation Violation?0..1integer
.... tblASILegalStatus.L5How many times in your life have you been arrested and charged with Drug Charges?0..1integer
.... tblASILegalStatus.L6How many times in your life have you been arrested and charged with Forgery?0..1integer
.... tblASILegalStatus.L7How many times in your life have you been arrested and charged with Weapon Offenses?0..1integer
.... tblASILegalStatus.L8How many times in your life have you been arrested and charged with Burglary/Larceny/Breaking and Entering?0..1integer
.... tblASILegalStatus.L9How many times in your life have you been arrested and charged with Robbery?0..1integer
.... tblASILegalStatus.L10How many times in your life have you been arrested and charged with Assault?0..1integer
.... tblASILegalStatus.L11How many times in your life have you been arrested and charged with Arson?0..1integer
.... tblASILegalStatus.L12How many times in your life have you been arrested and charged with Rape?0..1integer
.... tblASILegalStatus.L13How many times in your life have you been arrested and charged with Homicide, Manslaughter?0..1integer
.... tblASILegalStatus.L14How many times in your life have you been arrested and charged with Prostitution?0..1integer
.... tblASILegalStatus.L15How many times in your life have you been arrested and charged with Contempt of Court?0..1integer
.... tblASILegalStatus.L16How many times in your life have you been arrested and charged with Other?0..1integer
.... tblASILegalStatus.L17How many of these charges resulted in convictions?0..1integer
.... tblASILegalStatus.L18How many times in your life have you been charged with Disorderly conduct, vagrancy, public intoxication?0..1integer
.... tblASILegalStatus.L19How many times in your life have you been charged with Driving while intoxicated?0..1integer
.... tblASILegalStatus.L20How many times in your life have you been charged with Major driving violations [reckless driving, speeding, no license, etc.]?0..1integer
.... tblASILegalStatus.L21How many months were you incarcerated in your life?0..1integer
.... tblASILegalStatus.L22How long was your last incarceration?0..1integer
.... tblASILegalStatus.L23What was it for?0..1choiceValue Set: NJSAMS ASI Crimes And Offenses
.... tblASILegalStatus.L24Are you presently awaiting charges, trial or sentence?0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASILegalStatus.L25What for0..1choiceValue Set: NJSAMS ASI Crimes And Offenses
.... tblASILegalStatus.L26How many days in the past 30 were you detained or incarcerated?0..1integer
.... tblASILegalStatus.L27How many days in the past 30 have you engaged in illegal activities for profit?0..1integer
.... tblASILegalStatus.L28How serious do you feel your present legal problems are? [Exclude civil problems]0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASILegalStatus.L29How important to you now is counseling or referral for these legal problems0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASILegalStatus.L30How would you rate the patients need for legal services or counseling?0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASILegalStatus.L31Is the above information significantly distorted by: Patient's misrepresentation0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASILegalStatus.L32Is the above information significantly distorted by: Patient's inability to understand0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASILegalStatus.LCommentsComments0..1text
... tblASIFamilySocialStatusnull0..1group
.... tblASIFamilySocialStatus.F1Marital Status0..1open-choiceValue Set: NJSAMS ASI Marital Status
.... tblASIFamilySocialStatus.F2YearsHow long have you been in this marital status: Years0..1integer
.... tblASIFamilySocialStatus.F2MonthsHow long have you been in this marital status: Months0..1integer
.... tblASIFamilySocialStatus.F3Are you satisfied with current marital status?0..1choiceValue Set: NJSAMS ASI Satisfied Status
.... tblASIFamilySocialStatus.F4Usual living arrangements [past 3 years]0..1open-choiceValue Set: NJSAMS ASI Usual Living Arrangement
.... tblASIFamilySocialStatus.F5YearsHow long have you lived in these arrangements?: Years0..1integer
.... tblASIFamilySocialStatus.F5MonthsHow long have you lived in these arrangements?: Months0..1integer
.... tblASIFamilySocialStatus.F6Are you satisfied with current living arrangements?0..1open-choiceValue Set: NJSAMS ASI Satisfied Status
.... tblASIFamilySocialStatus.F7Do you live with anyone who has a current alcohol problem?0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F8Do you live with anyone who uses non-prescribed drugs?0..1open-choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F9With whom do you spend most of your free time?0..1open-choiceValue Set: NJSAMS ASI Client Companion
.... tblASIFamilySocialStatus.F10Are you satisfied with spending your free time this way0..1open-choiceValue Set: NJSAMS ASI Satisfied Status
.... tblASIFamilySocialStatus.F11How many close friends do you have?0..1integer
.... tblASIFamilySocialStatus.F12Would you say you have had close, long lasting, personal relationships with any of the following people in your life: Mother0..1integer
.... tblASIFamilySocialStatus.F13Would you say you have had close, long lasting, personal relationships with any of the following people in your life: Father0..1integer
.... tblASIFamilySocialStatus.F14Would you say you have had close, long lasting, personal relationships with any of the following people in your life: Brothers/Sisters0..1integer
.... tblASIFamilySocialStatus.F15Would you say you have had close, long lasting, personal relationships with any of the following people in your life: Children0..1integer
.... tblASIFamilySocialStatus.F16Would you say you have had close, long lasting, personal relationships with any of the following people in your life: Friends0..1integer
.... tblASIFamilySocialStatus.F18DaysHave you had significant periods in which you have experienced serious problems getting along with: Mother: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F18LifeHave you had significant periods in which you have experienced serious problems getting along with: Mother: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F19DaysHave you had significant periods in which you have experienced serious problems getting along with: Father: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F19LifeHave you had significant periods in which you have experienced serious problems getting along with: Father: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F20DaysHave you had significant periods in which you have experienced serious problems getting along with: Brothers/Sisters: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F20LifeHave you had significant periods in which you have experienced serious problems getting along with: Brothers/Sisters: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F21DaysHave you had significant periods in which you have experienced serious problems getting along with: Sexual partner/spouse: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F21LifeHave you had significant periods in which you have experienced serious problems getting along with: Sexual partner/spouse: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F22DaysHave you had significant periods in which you have experienced serious problems getting along with: Children: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F22LifeHave you had significant periods in which you have experienced serious problems getting along with: Children: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F23DaysHave you had significant periods in which you have experienced serious problems getting along with: Other significant family: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F23LifeHave you had significant periods in which you have experienced serious problems getting along with: Other significant family: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F24DaysHave you had significant periods in which you have experienced serious problems getting along with: Close friends: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F24LifeHave you had significant periods in which you have experienced serious problems getting along with: Close friends: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F25DaysHave you had significant periods in which you have experienced serious problems getting along with: Neighbors: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F25LifeHave you had significant periods in which you have experienced serious problems getting along with: Neighbors: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F26DaysHave you had significant periods in which you have experienced serious problems getting along with: C0-Workers: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F26LifeHave you had significant periods in which you have experienced serious problems getting along with: C0-Workers: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F27DaysDid any of these people abuse you: Emotionally: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F27LifeDid any of these people abuse you: Emotionally: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F28DaysDid any of these people abuse you: Physically: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F28LifeDid any of these people abuse you: Physically: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F29DaysDid any of these people abuse you: Sexually: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F29LifeDid any of these people abuse you: Sexually: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F30How many days in the past 30 have you had serious conflicts: with your family?0..1integer
.... tblASIFamilySocialStatus.F31How many days in the past 30 have you had serious conflicts: with other people?[excluding family]0..1integer
.... tblASIFamilySocialStatus.F32How troubled or bothered have you been in the past 30 days by these: Family problems0..1open-choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIFamilySocialStatus.F33How troubled or bothered have you been in the past 30 days by these: Social problems0..1open-choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIFamilySocialStatus.F34How important to you now is treatment or counseling for these: Family problems0..1open-choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIFamilySocialStatus.F35How important to you now is treatment or counseling for these: Social problems0..1open-choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIFamilySocialStatus.F36How would you rate the patient's need for family and/or social counseling?0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASIFamilySocialStatus.F37Is the above information significantly distorted by: Patient's misrepresentation0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.F38Is the above information significantly distorted by: Patient's inability to understand0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIFamilySocialStatus.FCommentsComments0..1text
... tblASIPsychiatricStatusnull0..1group
.... tblASIPsychiatricStatus.P1How many times have you been treated for any psychological or emotional problems? : In a hospital0..1integer
.... tblASIPsychiatricStatus.P2How many times have you been treated for any psychological or emotional problems? : As on outpatient or private patient0..1integer
.... tblASIPsychiatricStatus.P3How many times have you been treated for any psychological or emotional problems? : Do you receive a pension for a psychiatric disability?0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P4DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced serious depression: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P4LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced serious depression: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P5DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced serious anxiety or tension: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P5LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced serious anxiety or tension: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P6DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced hallucinations: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P6LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced hallucinations: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P7DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced trouble understanding, concentrating or remembering : PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P7LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced trouble understanding, concentrating or remembering: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P8DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced trouble controlling violent behaviour: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P8LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced trouble controlling violent behaviour: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P9DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced serious thoughts of suicide: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P9LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Experienced serious thoughts of suicide: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P10DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Attempted suicide: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P10LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Attempted suicide: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P11DaysHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Been prescribed medication for any psychological emotional problem: PAST 30 DAYS0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P11LifeHave you had a significant period, (that was not a direct result of drug/alcohol use), in which you have: Been prescribed medication for any psychological emotional problem: IN YOUR LIFE0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P12How many days in the past 30 have you experienced these psychological or emotional problems?0..1integer
.... tblASIPsychiatricStatus.P13How much have you been troubled or bothered by these psychological or emotional problems in the past 30 days?0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIPsychiatricStatus.P14How important to you now is treatment for these psychological problems?0..1choiceValue Set: NJSAMS ASI Qualitative Rating
.... tblASIPsychiatricStatus.P15At the time of the interview, is patient: Obviously depressed/withdrawn0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P16At the time of the interview, is patient: Obviously hostile0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P17At the time of the interview, is patient: Obviously anxious/nervous0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P18At the time of the interview, is patient: Having trouble with reality testing thought disorders, paranoid thinking0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P19At the time of the interview, is patient: Having trouble comprehending, concentrating, remembering0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P20At the time of the interview, is patient: Having suicidal thoughts0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P21How would you rate the patient’s need for psychiatric/psychological treatment?0..1choiceValue Set: NJSAMS Client Need Rating
.... tblASIPsychiatricStatus.P22Is the above information significantly distorted by: Patient’s misrepresentation0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.P23Is the above information significantly distorted by: Patient’s inability to understand0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... tblASIPsychiatricStatus.PCommentsEmployement / Suport status Comments0..1text

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