FHIR Implementation Guide for NJSAMS


0.1.0 - draft New Jersey

NJSAMS - Local Development build (v0.1.0). See the Directory of published versions

Questionnaire: AdmissionQuestionnaire

Official URL: http://dhs.nj.gov/njsams/Questionnaire/AdmissionQuestionnaire Version: 0.1.0
Draft as of 2022-08-31 Computable Name:
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. Questionnairehttp://dhs.nj.gov/njsams/Questionnaire/AdmissionQuestionnaire#0.1.0
... adm-detailsnull0..1group
.... adm-details.1Is the use of medication planned as part of treatment?1..*open-choiceValue Set: NJSAMS Treatment Medications
.... adm-details.2Treatment Level of Care at admission1..1choiceValue Set: NJSAMS Treatment Level of Care
.... adm-details.3Medication will be prescribed by0..1open-choiceValue Set: NJSAMS Prescription/Dispensation Medication
.... adm-details.4Medication was dispensed by0..1open-choiceValue Set: NJSAMS Prescription/Dispensation Medication
... client-detailsnull0..1group
.... client-details.1Is the Client a Veteran?1..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... client-details.2Is Client Pregnant?0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... client-details.3Did the client give birth in the past 12 months0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... client-details.4Does the client have any children 17 years or younger1..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... client-details.5Is the client bringing dependent children into tx0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... client-details.6Living arrangement at the time of admission1..1choiceValue Set: NJSAMS Living Arrangement
.... client-details.7If Dependent/Supervised Living0..1open-choiceValue Set: NJSAMS Dependent/Supervised Living Arrangement
... education-employmentnull0..1group
.... education-employment.1What is the highest grade you completed in school?1..1choiceValue Set: NJSAMS Education Level
.... education-employment.2Are you currently enrolled in school or a job training program?1..1open-choiceValue Set: NJSAMS Enrollment in School/Job Training
.... education-employment.3If not enrolled0..1choiceValue Set: NJSAMS reasons why client is not in School/Job Training
.... education-employment.4Which best describes your CURRENT employment situation?1..1choiceValue Set: NJSAMS Employment Situation
.... education-employment.5Source of Income/Support0..*choiceValue Set: NJSAMS Source Of Income
... legal-self-helpnull0..1group
.... legal-self-help.1What is the clients current legal status0..*open-choiceValue Set: NJSAMS Current Legal Status
.... legal-self-help.2How many times have you been arrested and charged for an offense in the past 30 days?1..1integer
.... legal-self-help.3In the past 30 days did the client attend any Self-Help Groups?1..1choiceValue Set: NJSAMS Self-Help Groups
.... legal-self-help.4Frequency of attendance0..1choiceValue Set: NJSAMS Frequency of attendance to self-help recovery groups
... conditions-and-SUDnull0..1group
.... conditions-and-SUD.1Chronic health conditions1..1choiceValue Set: NJSAMS Client Chronic Conditions
.... conditions-and-SUD.2Does client currently use any tobacco products?1..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
.... conditions-and-SUD.3Tobacco products used0..1choiceValue Set: NJSAMS Tobacco Products
.... conditions-and-SUD.4Primary tobacco products used frequency0..1choiceValue Set: Smoking Status
.... conditions-and-SUD.5What treatment techniques/tools were effective1..1choiceValue Set: NJSAMS Tobacco Use Treatments
.... conditions-and-SUD.6Was this client referred to0..1choiceValue Set: NJSAMS Tobacco Treatment Agencies
.... primary-drugnull0..1group
..... primary-drug.1Primary Drug Category1..1choiceValue Set: NJSAMS Drugs Used
..... primary-drug.2Primary Drug Frequency of Use1..1choiceValue Set: NJSAMS Drug Use Frequency
..... primary-drug.3Primary Drug Age at First Use1..1integer
..... primary-drug.4Primary Drug Route of administration1..1choiceValue Set: NJSAMS Drug Route of Administration
.... secondary-drugnull0..1group
..... secondary-drug.1Secondary Drug Category1..*choiceValue Set: NJSAMS Drugs Used
..... secondary-drug.2Secondary Drug Frequency of Use1..1choiceValue Set: NJSAMS Drug Use Frequency
..... secondary-drug.3Secondary Drug Age at First Use0..1integer
..... secondary-drug.4Secondary Drug Route of administration1..1choiceValue Set: NJSAMS Drug Route of Administration
.... tertiary-drugnull0..1group
..... tertiary-drug.1Tertiary Drug Category1..1choiceValue Set: NJSAMS Drugs Used
..... tertiary-drug.2Tertiary Drug Frequency of Use1..1choiceValue Set: NJSAMS Drug Use Frequency
..... tertiary-drug.3Tertiary Drug Age at First Use0..1integer
..... tertiary-drug.4Tertiary Drug Route of administration1..1choiceValue Set: NJSAMS Drug Route of Administration
.... conditions-and-SUD.7Target/Special Population1..*choiceValue Set: NJSAMS Target Populations
.... treatment-historynull0..1group
..... treatment-history.1In the past 30 days was the client treated in an emergency room for Alcohol and Drug Problems?0..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
..... treatment-history.2Number of past alcohol and drug treatment episodes1..1integer
..... treatment-history.3Was naloxone administered in the past 30 days1..1choiceValue Set: https://hl7.org/fhir/R4/valueset-example-yesnodontknow.html
..... treatment-history.4Who administered the Naloxone in the past 30 days1..*open-choiceValue Set: NJSAMS Naloxone Administrator
..... treatment-history.5Enter the total number of days between the clients first contact and first treatment day at your agency1..1integer
..... treatment-history.6Reason to Wait for Treatment0..1open-choiceValue Set: NJSAMS Delayed Treatment
.... health-insurancenull0..1group
..... health-insurace.1Health Insurance0..*choiceValue Set: NJSAMS Insurance Types
.... admission-commentsnull0..1group
..... admission-comments.1Admission Comments0..1text

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