FHIR Implementation Guide for NJSAMS
1.0.0 - release
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
| Official URL: https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/Dimension1 | Version: 1.0.0 | |||
| Draft as of 2022-08-31 | Computable Name: | |||
Justification for level of care score (see ServiceRequest) in Dimension 1
Generated Narrative: Questionnaire Dimension1
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | Justification for level of care score (see ServiceRequest) in Dimension 1 | Questionnaire | https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/Dimension1#1.0.0 | |
  LOCI3Dimension1 | null | 0..1 | group | |
   LOCI3Dimension1.D1Proceeda | a. There is no recent use OR | 0..1 | boolean | |
| LOCI3Dimension1.D1Proceedb | b. No indication of acute intoxication or withdrawal problems OR | 0..1 | boolean | |
| LOCI3Dimension1.D1Proceedc | c. There is recent use and/or indication of Acute Intoxication / Withdrawal Potential | 0..1 | boolean | |
| Level1 | Level 1-WM – AMBULATORY WITHDRAWAL MANAGEMENT WITHOUT EXTENDED ONSITE MONITORING | 0..1 | group | |
 LOCI3Dimension1.Level1.D1Level1Da1 | 1. Alcohol:Presence of mild to moderate symptoms of withdrawal, with a CIWA-Ar score of less than 10, or the equivalent for a comparable standardized scoring system; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da2 | 2. Sedative/hypnotics:Recent use confined to therapeutic levels, not complicated by daily use of alcohol or other drugs known to produce a significant withdrawal syndrome OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da3 | 3. Sedative/hypnotics:Reliable history that patient is withdrawing from therapeutic doses of sedative/hypnotics, but no evidence of other severe substance use disorder. Symptoms have responded to, or likely to respond to, substitute doses of sedative/hypnotics in the therapeutic range within 2 hours; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da4 | 4. Opioids [withdrawal management not using opioid agonist medication]: Use of high-potency opioids has not been daily for more than 2 weeks preceding admission, or use of opioids near the therapeutically recommended level; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da5 | 5. Opioids [withdrawal management using opioid agonist medication]:Patient being withdrawn gradually from opioid agonist medication or being treated for mild opioid withdrawal symptoms; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da6 | 6. Stimulants:Patient withdrawing from stimulants, experiencing some lethargy, agitation, paranoia, mild psychotic symptoms, or depression, but has good impulse control OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da7 | 7. Nicotine:Patient is withdrawing from nicotine,experiencing withdrawal symptoms that require either nicotine replacement therapies or nonnicotine agents for symptomatic treatment | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Da1 | 1. Alcohol:Presence of mild to moderate symptoms of withdrawal, with a CIWA-Ar score of less than 10, or the equivalent for a comparable standardized scoring system; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Db2 | 2. Has adequate support services to ensure commitment to completion of withdrawal management and entry into ongoing treatment or recovery OR | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Db3 | 3. Willing to accept recommendation for treatment | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Dc1 | 1. Decreased emotional symptoms at the close of initial treatment session; AND | 0..1 | boolean | |
| LOCI3Dimension1.Level1.D1Level1Dc2 | 2. Patient’s or support person’s ability to clearly understand instructions for care, and presence of both ability and resources to follow instructions. | 0..1 | boolean | |
| Level2 | Level 2-WM – AMBULATORY WITHDRAWAL MANAGEMENT WITH EXTENDED ON-SITE MONITORING | 0..1 | group | |
| LOCI3Dimension1.Level2.D1Level2Da1 | a.Moderate risk of severe withdrawal syndrome outside the program setting; | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db1 | 1.Alcohol:CIWA-Ar score of 10 to 25, or the equivalent for a comparable standardized scoring system;OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db2 | 2. Sedative/hypnotics:Reliable history that patient is withdrawing from sedative/hypnotics and withdrawal symptoms have responded to, or likely to respond to, substitute doses of sedative/hypnotics within observable hours of the program; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db3 | 3. Sedative/hypnotics:Has ingested sedative/hypnotics in excess of therapeutic levels daily for at least 4 weeks, but risk of seizures, hallucinations, dissociation, or severe affective disorder during unobserved periods outside program is minimal. Close hourly monitoring is available, if needed. No accompanying chronic mental or physical disorder that poses a danger to patient during withdrawal; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db4 | 4. Sedative/hypnotics:Has ingested sedative/hypnotics at not more than therapeutic levels daily for at least 6 months, in combination with daily alcohol use or regular use of another mind-altering drug known to have its own dangerous withdrawal syndrome. Risk of seizures, hallucinations, dissociation, or severe affective symptoms outside program is minimal; OR OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db5 | 5. Opioids [withdrawal management not using opioid agonist medication]: The abstinence syndrome—indicated by vital signs and evidence of physical discomfort/craving—can be stabilized by end of each day’s monitoring, so that patient can manage such symptoms at home with appropriate supervision; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db6 | 6. Opioids [withdrawal management using opioid agonist medication]:Withdrawal signs and symptoms are of such severity or instability that extended monitoring is required to determine appropriate dosage; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Db7 | 7. Stimulants:Withdrawing from stimulants and experiencing significant lethargy, agitation, paranoia, psychotic symptoms, or depression, and requires extended outpatient monitoring to determine impulse control and readiness for Level 1-WM ambulatory withdrawal management services or the need for Level 3.2- WM withdrawal management services. | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Dc1 | 1. Patient or support persons clearly understand instructions for care and are able to follow instructions; AND | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Dc2 | 2. Has an adequate understanding of ambulatory withdrawal management, has expressed commitment to enter such a program; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Dc3 | 3. Has adequate support services to ensure commitment to completion of withdrawal management and entry into ongoing treatment or recovery; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level2.D1Level2Dc4 | 4. Willingness to accept recommendation for treatment once withdrawal has been managed. | 0..1 | boolean | |
| Level3.2 | Level 3.2-WM – CLINICALLY MANAGED RESIDENTIAL WITHDRAWAL MANAGEMENT | 0..1 | group | |
| LOCI3Dimension1.Level3.2.D1Level3_2Da1 | 1. Alcohol:Intoxicated or withdrawing from alcohol and CIWA-Ar score is less than 8 at admission, and monitoring is available to assure that it remains less than 8, or the equivalent for a comparable standardized scoring system; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.2.D1Level3_2Da2 | 2. Opioids: Withdrawal signs and symptoms are distressing but do not require medication for reasonable withdrawal discomfort, and the patient is impulsive and lacks skills needed to prevent immediate continued drug use; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.2.D1Level3_2Da3 | 3. Stimulants:Has marked lethargy, hypersomnolence, paranoia, or mild psychotic symptoms due to stimulant withdrawal; these are still present beyond a period of outpatient monitoring available in Level 2-WM services | 0..1 | boolean | |
| LOCI3Dimension1.Level3.2.D1Level3_2Db1 | 1. Recovery environment not supportive of withdrawal management and entry into treatment; does not have sufficient coping skills to safely deal with problems in the recovery environment; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.2.D1Level3_2Db2 | 2. Has a recent history of withdrawal management at less intensive levels of service, marked by inability to complete withdrawal management or to enter into continuing addiction treatment; patient continues to have insufficient skills to complete withdrawal management; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.2.D1Level3_2Db3 | 3. Recently has demonstrated inability to complete withdrawal management at a less intensive level of service, as by continued use of other-than-prescribed drugs or other mindaltering substances. | 0..1 | boolean | |
| Level3.7 | Level 3.7-WM – MEDICALLY MONITORED INPATIENT WITHDRAWAL MANAGEMENT | 0..1 | group | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da1 | 1. Alcohol:Withdrawing from alcohol, the CIWA-Ar score is 19 or greater [or the equivalent for a standardized scoring system] by end of the period of outpatient monitoring available in Level 2-WM; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da2 | 2. Alcohol and Sedative/Hypnotics:Has marked lethargy or hypersomnolence due to intoxication with alcohol or other drugs, a history of severe withdrawal syndrome, or patient’s altered level of consciousness has not stabilized at the end of the period of outpatient monitoring available at Level 2-WM; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da3 | 3. Sedative/hypnotics:Has ingested sedative/hypnotics at more than therapeutic levels daily for more than 4 weeks and is not responsive to appropriate recent efforts to maintain dose at therapeutic levels; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da4 | 4. Sedative/hypnotics:Has ingested sedative/hypnotics at more than therapeutic levels daily for more than 4 weeks, in combination with daily alcohol use or regular use of another mind-altering drug known to pose a severe risk of withdrawal. Signs and symptoms of withdrawal are of moderate severity, and patient cannot be stabilized by Norman G. Hoffmann, Ph.D. 5 end of the period of outpatient monitoring available at Level 2-WM; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da5 | 5. Opioids [withdrawal management not using opioid agonist medication]: [withdrawal management not using opioid agonist medication]: Has used opioids daily for more than 2 weeks and has history of inability to complete withdrawal as an outpatient or without medication in a Level 3.2-WM service; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da6 | 6. Opioids [withdrawal management using opioid agonist medication]:Antagonist medication is to be used in withdrawal in brief but intensive withdrawal management [as in multiday pharmacological induction onto naltrexone]; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Da7 | 7. Stimulants:Has marked lethargy, hypersomnolence, agitation, paranoia, depression, or mild psychotic symptoms due to stimulant withdrawal; has poor impulse control and/or coping skills to prevent immediate continued drug use. | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Db1 | 1. Requires medication and has recent history of withdrawal management at a less intensive level of care, marked by past and current inability to complete withdrawal management and enter into continuing addiction treatment. Continues to have insufficient skills/supports to complete withdrawal management; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Db2 | 2. Has recent history of withdrawal management at less intensive levels of service, marked by inability to complete withdrawal management or to enter into continuing addiction treatment; continues to have insufficient skills to complete withdrawal management; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level3.7.D1Level3_7Db3 | 3. Has a comorbid physical, emotional, behavioral, or cognitive condition, manageable in a Level 3.7-WM setting, but which increases clinical severity of the withdrawal and complicates withdrawal management. | 0..1 | boolean | |
| Level4 | Level 4-WM – MEDICALLY MANAGED INTENSIVE INPATIENT WITHDRAWAL MANAGEMENT | 0..1 | group | |
| LOCI3Dimension1.Level4.D1Level4Da1 | 1. Alcohol: Withdrawing from alcohol, CIWA-Ar score is 19 or greater [or the equivalent for a comparable standardized scoring system], and patient requires monitoring more often than hourly; requires intravenous medication or infusions; or requires close behavioral monitoring because of high levels of agitation, confusion, or extremes of vital signs; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da2 | 2. Alcohol and Sedative/Hypnotics:Experiencing seizures; delirium tremens; or severe, chronic hallucinations; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da3 | 3. Sedative/Hypnotics:Has ingested sedative/hypnotics at more than therapeutic levels daily for more than 4 weeks; has an accompanying acute mental or physical disorder that is complicating withdrawal; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da4 | 4. Sedative/hypnotics:Has ingested sedative/hypnotics daily for at least 6 months, in combination with daily alcohol use or regular use of another mind-altering drug known to pose a severe withdrawal syndrome; has an accompanying acute mental or physical disorder that is complicating withdrawal; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da5 | 5. Opioids: Experiencing a severe opioid withdrawal syndrome that has not been stabilized or managed at a less intensive level of service; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da6 | 6. Stimulants:Intoxication or withdrawal signs and symptoms require psychiatric or medical monitoring more frequently than hourly [because of psychotic, impulsive behavior or depressive suicidality]; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da7 | 7. All Substances:Recent [within 24 hours] serious head trauma or loss of consciousness, with chronic mental status or neurological changes resulting in the need to closely observe the patient at least hourly; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da8 | 8. All Substances:Drug overdose or intoxication has compromised mental status, cardiac function, or other vital signs or functions OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Da9 | 9. All Substances:Has a significant acute biomedical disorder that poses substantial risk of serious or life-threatening consequences during withdrawal; | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Db1 | 1. A withdrawal management regimen or patient’s response to that regimen requires monitoring or intervention more frequently than hourly; OR | 0..1 | boolean | |
| LOCI3Dimension1.Level4.D1Level4Db2 | 2. Needs withdrawal management or stabilization while pregnant, until patient can be safely treated in a less intensive level of care. | 0..1 | boolean | |
| Documentation for this format | ||||