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/Dimension3 | Version: 1.0.0 | |||
| Draft as of 2022-08-31 | Computable Name: | |||
Justification for level of care score (see ServiceRequest) in Dimension 3
Generated Narrative: Questionnaire Dimension3
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | Justification for level of care score (see ServiceRequest) in Dimension 3 | Questionnaire | https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/Dimension3#1.0.0 | |
  LOCI3Dimension3 | null | 0..1 | group | |
   LOCI3Dimension3.D3Proceeda | a. No indication of co-occurring mental health disorders; OR | 0..1 | boolean | |
| LOCI3Dimension3.D3Proceedb | b. Emotional, behavioral, or cognitive problems are very mild and do not require further assessment, services, monitoring or management OR | 0..1 | boolean | |
| LOCI3Dimension3.D3Proceedc | c. There are indications of a co-occurring mental health disorder | 0..1 | boolean | |
| Level0_5 | LEVEL 0.5 - EARLY INTERVENTION | 0..1 | group | |
 LOCI3Dimension3.Level0_5.D3Level0_5OPa | a. Emotional, behavioral, or cognitive conditions and complications, if any, are being addressed through appropriate mental health services, and thus will not interfere with therapeutic interventions. | 0..1 | boolean | |
| Level1 | LEVEL 1.0 - OUTPATIENT SERVICES | 0..1 | group | |
| LOCI3Dimension3.Level1.D3Level1OPa | a. No symptoms of a co-occurring mental disorder, or any symptoms are mild, stable, fully related to a substance use or other addictive disorder, and do not interfere with ability to focus on addiction treatment | 0..1 | boolean | |
| LOCI3Dimension3.Level1.D3Level1OPb | b. Psychiatric symptoms are mild, mostly stable, and primarily related to a substance use or other addictive disorder, or to a co-occurring cognitive, emotional, or behavioral condition. Mental health monitoring | 0..1 | boolean | |
| LOCI3Dimension3.Level1.D3Level1OPc | c. Mental status does not preclude ability to both: 1. Understand the information presented; AND 2. Participate in the treatment planning and treatment process; AND | 0..1 | boolean | |
| LOCI3Dimension3.Level1.D3Level1OPd | d. Does not pose a risk of harm to self or others and is not vulnerable to victimization by another. | 0..1 | boolean | |
| Level1CO | LEVEL 1.0 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level1CO.D3Level1DDEa | a. Severe and chronic mental illness impairs patient’s ability to follow through consistently with mental health appointments and psychotropic medication. However, patient has ability to access services that will help | 0..1 | boolean | |
| LOCI3Dimension3.Level1CO.D3Level1DDEb | b. A severe and chronic mental disorder or other emotional, behavioral, or cognitive problems, or substance-induced disorder; AND | 0..1 | boolean | |
| LOCI3Dimension3.Level1CO.D3Level1DDEc | c. Mental health functioning is such that patient has impaired ability to both: 1. Understand the information presented AND 2. Participate in treatment planning and the treatment process. Mental health management is required to stabilize mood, cognition, and behavior | 0..1 | boolean | |
| LOCI3Dimension3.Level1CO.D3Level1DDEd | d. Does not pose a risk of harm to self or others and not vulnerable to victimization by another. | 0..1 | boolean | |
| Level2_1 | LEVEL 2.1 - INTENSIVE OUTPATIENT | 0..1 | group | |
| LOCI3Dimension3.Level2_1.D3Level2_1OPa | Engages in abuse of family members or significant others, and requires intensive outpatient treatment to reduce the risk of further deterioration OR | 0..1 | boolean | |
| LOCI3Dimension3.Level2_1.D3Level2_1OPb | A diagnosed emotional, behavioral, or cognitive disorder that requires intensive outpatient monitoring to minimize distractions from treatment or recovery. | 0..1 | boolean | |
| Level2_1DDE | LEVEL 2.1 -Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level2_1DDE.D3Level2_1DDEa | a. A diagnosed emotional, behavioral, or cognitive disorder that requires management because patient history suggests high potential for distraction from treatment such a disorder requires stabilization | 0..1 | boolean | |
| LOCI3Dimension3.Level2_1DDE.D3Level2_1DDEb | b. At mild risk of behaviors endangering self, others, or property OR | 0..1 | boolean | |
| LOCI3Dimension3.Level2_1DDE.D3Level2_1DDEc | c. At significant risk of victimization by another.However, the risk is not severe enough to require 24-hour supervision. | 0..1 | boolean | |
| Level2_5 | LEVEL 2.5 - PARTIAL HOSPITALIZATION SERVICES | 0..1 | group | |
| LOCI3Dimension3.Level2_5.D3Level2_5PCa | a. A history of mild to moderate psychiatric decompensation [marked by paranoia or mild psychotic symptoms] on discontinuation of the drug use. Such decompensation may occur and requires monitoring to permit | 0..1 | boolean | |
| Level2_5DDE | LEVEL 2.5 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level2_5DDE.D3Level2_5DDEa | a. A diagnosed emotional, behavioral, or cognitive disorder that requires management because patient history suggests high potential for distraction from treatment such a disorder requires stabilization | 0..1 | boolean | |
| LOCI3Dimension3.Level2_1DDE.D3Level2_5DDEb | b. At mild risk of behaviors endangering self, others, or property OR | 0..1 | boolean | |
| LOCI3Dimension3.Level2_1DDE.D3Level2_5DDEc | c. At significant risk of victimization by another.However, the risk is not severe enough to require 24-hour supervision. | 0..1 | boolean | |
| Level3_1 | LEVEL 3.1 - CLINICALLLY MANAGED LOW-INTENSITY RESIDENTIAL TREATMENT | 0..1 | group | |
| LOCI3Dimension3.Level3_1.D3Level3_1HHa | a. Mental status [including emotional stability and cognitive functioning] assessed as sufficiently stable to allow patient to participate in the therapeutic interventions provided at this level of care and to benefit from treatment AND | 0..1 | boolean | |
| LOCI3Dimension3.Level3_1.D3Level3_1HHb | b. Psychiatric condition is stable, and patient has minimal problems in this area, as evidenced by both of the following: [1] thought disorder, anxiety, guilt, and/or depression may be related to substance use problems or to a stable co-occurring emotional, behavioral, or cognitive condition, with imminent likelihood of relapse with dangerous consequences outside of a structured environment and [2] does not pose a risk to self or others OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_1.D3Level3_1HHc | c. SSymptoms and functional limitations, when considered in the context of patient home environment, are sufficiently severe that patient is not likely to maintain mental stability and/or abstinence if treatment is provided in a nonresidential setting OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_1.D3Level3_1HHd | d. Demonstrates [through distractibility, negative emotions, or generalized anxiety] an inability to maintain stable behavior over a 24-hour period without the structure and support of a 24-hour setting OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_1.D3Level3_1HHe | e. Co-occurring psychiatric, emotional, behavioral, or cognitive conditions are being addressed concurrently through appropriate psychiatric services. | 0..1 | boolean | |
| Level3_1DDE | LEVEL 3.1 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level3_1DDE.D3Level3_1DDEa | a. A diagnosed emotional, behavioral, or cognitive disorder that requires monitoring of medications or assessment of psychiatric symptoms or behavioral management techniques, because patient history suggests that these disorders are likely to distract from treatment efforts AND | 0..1 | boolean | |
| LOCI3Dimension3.Level3_1DDE.D3Level3_1DDEb | b. Needs monitoring of psychiatric symptoms concurrent with addiction treatment OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_1DDE.D3Level3_1DDEc | c. Able to safely access the community for work, education, and other community resources. OR | 0..1 | boolean | |
| Level3_3 | LEVEL 3.3 - CLINICALLY MANAGED MEDIUM-INTENSITY RESIDENTIAL TREATMENT | 0..1 | group | |
| LOCI3Dimension3.Level3_3.D3Level3_3LTRa | a. A diagnosed emotional, behavioral, or cognitive disorder that requires active management. Such disorders complicate treatment of substance use or substance-induced disorder and require differential diagnosis. Patient thus is in need of stabilization of psychiatric symptoms concurrent with addiction treatment. May require treatment delivered at a slower pace or in a more concrete or repetitive fashion AND | 0..1 | boolean | |
| LOCI3Dimension3.Level3_3.D3Level3_3LTRb | b. Psychiatric condition is stabilizing, but patient is in need of a 24-hour structured environment, as evidenced by one of the following: [1] depression or other emotional, behavioral, or cognitive conditions significantly interfere with activities of daily living and recovery or [2] patient exhibits violent or disruptive behavior when intoxicated, poses a danger to self or others or [3] patient exhibits stress behaviors related to recent or threatened losses in work, family, or social arenas, such that activities of daily living are significantly impaired and patient requires a secure environment to focus on substance use or mental health problem or [4] concomitant personality disorders are of such severity that accompanying dysfunctional behaviors require continuing structured interventions OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_3.D3Level3_3LTRc | c. Symptoms and functional limitations, when considered in the context of patient home environment, are sufficiently severe that patient is not likely to maintain mental stability and/or abstinence if treatment is provided in a non-residential setting OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_3.D3Level3_3LTRd | d. At mild risk of behaviors endangering self, others, or property in imminent danger of relapse without the 24-hour support and structure of a Level 3.3 program. OR | 0..1 | boolean | |
| Level3_3DDE | LEVEL 3.3 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level3_3DDE.D3Level3_3DDEa | a. A diagnosed emotional, behavioral, or cognitive disorder that requires active management. Such disorders complicate treatment of substance use or substance-induced disorder and require differential diagnosis. Patient thus is in need of stabilization of psychiatric symptoms concurrent with addiction treatment. May require treatment delivered at a slower pace or in a more concrete or repetitive fashion OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_3DDE.D3Level3_3DDEb | b. At mild to moderate risk of behaviors endangering self,others, or property OR | 0..1 | boolean | |
| Level3_5 | LEVEL 3.5 - CLINICALLY MANAGED HIGHINTENSITY RESIDENTIAL TREATMENT | 0..1 | group | |
| LOCI3Dimension3.Level3_5.D3Level3_5LTRa | a. Mental status [including emotional stability and cognitive functioning] is sufficiently stable to permit patient to participate in the therapeutic interventions provided at this level of care and to benefit from treatment AND | 0..1 | boolean | |
| LOCI3Dimension3.Level3_5.D3Level3_5LTRb | b. Psychiatric condition is stabilizing. However, despite best efforts, patient is unable to control use of alcohol, tobacco, and/or other drugs and/or antisocial behaviors,with attendant probability of imminent danger.Resulting level of dysfunction is so severe that it precludes patient participation in a less structured and intensive level of care OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_5.D3Level3_5LTRc | c. Demonstrates repeated inability to control impulses to use alcohol and/or other drugs and/or to engage in antisocial behavior, and is in imminent danger of relapse, with attendant likelihood of harm to self, others, or property. Resulting level of dysfunction is of such severity that it precludes participation in treatment in the absence of the 24-hour support and structure of a Level 3.5 program OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_5.D3Level3_5LTRd | d. Demonstrates antisocial behavior patterns [as evidenced by criminal activity] that have led or could lead to significant criminal justice problems, lack of concern for others, and extreme lack of regard for authority, and which prevents movement toward positive change and precludes participation in a less structured and intensive level of care OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_5.D3Level3_5LTRe | e. Significant functional deficits, which are likely to respond to staff interventions. Symptoms and deficits, when considered in context of the home environment, are sufficiently severe that patient is not likely to maintain mental stability and/or abstinence if treatment is provided in a non-residential setting. Functional deficits are of a pervasive nature, requiring treatment that is primarily habilitative in focus they do not require medical monitoring or managemen OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_5.D3Level3_5LTRf | f. Concomitant personality disorders are of such severity that accompanying dysfunctional behaviors provide opportunities to promote continuous boundary setting interventons. | 0..1 | boolean | |
| Level3_5DDE | LEVEL 3.5 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level3_5DDE.D3Level3_5DDEa | a. A range of psychiatric symptoms that require active monitoring. These pose a risk of harm to self or others if patient is not contained in a 24-hour structured environment. 24-hour milieu sufficient to contain such impulses, but enhanced staff and therapeutic interventions are required to manage unpredictable losses of impulse control. | 0..1 | boolean | |
| Level3_7 | LEVEL 3.7 - MEDICALLY MONITORED INTENSIVE INPATIENT SERVICES | 0..1 | group | |
| LOCI3Dimension3.Level3_7.D3Level3_7STRa | a. Psychiatric condition is unstable and presents with symptoms interfering with abstinence, recovery, and stability to such a degree that patient needs a structured 24-hour, medically monitored [but not medically managed] environment to address recovery efforts OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7.D3Level3_7STRb | b. Exhibits stress behaviors associated with recent or threatened losses in work, family, or social domains or there is a reemergence of feelings and memories of trauma and loss once patient achieves abstinence, to a degree that his or her ability to manage the activities of daily living is significantly impaired. Patient thus requires a secure, medically monitored environment in which to address self-care problems and to focus on substance use or behavioral health problems OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7.D3Level3_7STRc | c. Significant functional limitations that require active psychiatric monitoring OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7.D3Level3_7STRd | d. At moderate risk of behaviors endangering self, others,or property, likely to result in imminent incarceration or loss of custody of children, and/or is in imminent danger of relapse [with dangerous emotional, behavioral, or cognitive consequences] without the 24-hour support and structure of a Level 3.7 program OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7.D3Level3_7STRe | e. Actively intoxicated, with resulting violent or disruptive behavior that poses imminent danger to self or others. May, on further evaluation, belong in Level 4-WM or an acute observational setting if assessed as not safe in a Level 3.7 service OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7.D3Level3_7STRf | f. Thought disorders or cognitive limitations require stabilization but not medical management in a 24-hour environment. | 0..1 | boolean | |
| Level3_7DDE | LEVEL 3.7 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension3.Level3_7DDE.D3Level3_7DDEa | a. A history of moderate psychiatric decompensation, or such symptoms occur during discontinuation of addictive drugs or when experiencing decompensation during post-acute withdrawal symptoms OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7DDE.D3Level3_7DDEb | b. At moderate to high risk of behaviors endangering self,others or property, or is in imminent danger of relapse [with dangerous emotional, behavioral, or cognitive consequences] without 24-hour structure and support and medically monitored treatment OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7DDE.D3Level3_7DDEc | c. Severely depressed, with suicidal urges and a plan. However, patient able to reach out for help as needed and does not require a one-on-one suicide watch OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7DDE.D3Level3_7DDEd | d. A co-occurring psychiatric disorder [such as anxiety,distractibility, or depression] interfering with patient addiction treatment or ability to participate in a less intensive level of care, and thus requires stabilization with psychotropic medications OR | 0..1 | boolean | |
| LOCI3Dimension3.Level3_7DDE.D3Level3_7DDEe | e. A co-occurring psychiatric disorder of moderate to high severity that is marginally and tenuously stable and requires care to prevent further decompensation. Patient requires co-occurring enhanced services and is best served in an addiction treatment program with integrated mental health services, or in a mental health program with integrated addiction treatment services. | 0..1 | boolean | |
| Level4 | LEVEL 4 -MEDICALLY MANAGED INPATIENT SERVICES (Co-occurring Enhanced) | 0..1 | group | |
| LOCI3Dimension3.Level4.D3Level4HBRa | a. Emotional, behavioral, or cognitive complications of addictive disorder require psychiatric management and skilled nursing care OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRb | b. A concurrent emotional, behavioral, or cognitive illness requires stabilization, daily psychiatric management, and primary nursing interventions OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRc | c. Uncontrolled behavior poses imminent danger to self or others OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRd | d. Mental confusion or fluctuating orientation poses imminent danger to self or others OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRe | e. A concurrent serious emotional, behavioral, or cognitive disorder complicates treatment of addiction and requires differential diagnosis and treatment OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRf | f. Extreme depression poses imminent risk to safety OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRg | g. Impairment of patient thought processes or abstract thinking, limitations in ability to conceptualize, and impairment in ability to manage the activities of daily living pose an imminent risk to safety OR | 0..1 | boolean | |
| LOCI3Dimension3.Level4.D3Level4HBRh | h. Continued use causing grave complications or exacerbation of a previously diagnosed psychiatric, emotional, or behavioral condition OR | 0..1 | boolean | |
| Manifestation | i. Experiencing altered mental status, with or without delirium, as manifested by: | 0..1 | group | |
| LOCI3Dimension3.Manifestation.D3Level4HBRi1 | 1. Disorientation to self OR | 0..1 | boolean | |
| LOCI3Dimension3.Manifestation.D3Level4HBRi2 | 2. Alcoholic hallucinosis OR | 0..1 | boolean | |
| LOCI3Dimension3.Manifestation.D3Level4HBRi3 | 3. Toxic psychosis | 0..1 | boolean | |
| Documentation for this format | ||||