crosswalk management system - dasis home page · k = key field item notreatment episode data set...

REPORT CROSSWALK TO STATE

27-DEC-16 09:08Report Date :

Run by :

Report :

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Filename :

Crosswalk Management System

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Crosswalk Report

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Status : FN

Start Date : 01-JUL-90End Date :

Follow-up :

Media ID : PFS

North CarolinaSystem

K

1

2

3

System Transaction Type

State Code

Reporting Date

A

C

D

Add

Change

Delete

Add

Change

Delete

Transaction Type Added to Each Record

FIPS Code Added to Each Record

Month and Year of Submission (Reporting date)

-

-

-

K = Key Field

Treatment Episode Data SetItem No Item Value State System Data

Substance Abuse and Mental Health Services AdministrationCenter for Behavioral Health Statistics and Quality

North Carolina's Treatment Episode Data SetVersion : 1

A

C

D

(MMYYYY)

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North CarolinaMinimum

K

K

K

K

K

1

2

3

4

5

State Provider Identifer

Client Identifer (Admission)

Co-Dependent/Collateral

Client Transaction Type

Date of Admission

2

A

M

T

X

No co-dependent or collateral records in data

Initial Admission

Initial admission (MH)

Transfer/Change in Service

Transfer or change in service (MH)

No

Admission (SA)

Initial Admission (MH)

Transfer/Change in Service (SA)

Transfer or Change in Service (MH)

Provider ID

Unique Identifier

Codependent/Collateral Data

Client transaction type

Date Admitted

--

--

--

--

--

K = Key Field



2

A

M

T

X

MMDDYYYY

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6

6

Prior Treatment Episodes

Prior Treatment Episodes

0

1

2

3

4

5

0

1

2

3

4

5

7

0 previous episodes

1 previous episodes

2 previous episodes

3 previous episodes

4 previous episodes

5 or more previous episodes

0 previous episodes

1 previous episodes

2 previous episodes

3 previous episodes

4 previous episodes

5 or more Previous episodes

Unknown

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

Unknown

Prior Admissions for substance abuse

Prior Admissions for substance abuse

--

--

K = Key Field



0

1

2

3

4

5

0

1

2

3

4

5

7

No longer effective as of: 12-31-2006

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7 Principal Source of Referral

01

10

11

12

21

22

26

32

34

41

44

46

48

49

51

60

71

80

Self

Family, Relatives

Friends

Employer

Other Inpatient Facility (Non State)

Inpatient/Residential Facility (State)

Drug/Alcohol Inpatient/Residential (State)

Psychiatric Non Residential Program

Drug/Alcohol Inpatient/Residential (NonState)

Private Physician

Nursing Home, Board and Care Home

Veterans Administration

Developmental Evaluation Center

Other Medical or Health Agency

Non Medical Professional

Social Service Agency

Court, Corrections, Prisons

Education

Individual (includes self-referral))



Employer/Employer Assistance ProgramEAP

Other Health Care Provider


Alcohol/Drug Abuse Provider




Other Community Referral






Court/Criminal Justice/DUI/DWI

School (Educational)

Referring Agent (Principal Source)--

K = Key Field



01

01

01

05

03

03

02

03

02

03

06

06

03

03

06

06

07

04

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92

93

96

97

Alcoholic's Anonymous

Vocational Rehab

Shelter for Homeless/Abused

Unknown




Unknown


K = Key Field



06

06

06

97

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01

10

11

12

21

22

26

32

34

41

44

46

48

49

51

60

71

80

Self

Family, Relatives

Friends

Employer

Other Inpatient Facility (Non State)

Inpatient/Residential Facility (State)

Drug/Alcohol Inpatient/Residential (State)

Psychiatric Non Residential Program

Drug/Alcohol Inpatient/Residential (NonState)

Private Physician

Nursing Home, Board and Care Home

Veterans Administration

Developmental Evaluation Center

Other Medical or Health Agency

Non Medical Professional

Social Service Agency

Court, Corrections, Prisons

Education




Employer/Employer Assistance ProgramEAP














School (Educational)


K = Key Field



01

01

01

05

03

03

02

03

02

03

06

06

03

03

06

06

07

04

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7

8

9

9

Principal Source of Referral

Date of Birth

Gender

Gender

82

92

93

96

99

1

2

7

F

M

U

Police

Alcoholic's Anonymous

Vocational Rehab

Shelter for Homeless/Abused

Other

Male

Female

Unknown

Female

Male

Unknown





Unknown

Male

Female

Unknown

Female

Male

Unknown

Referring Agent (Principal Source)

Date of birth

Sex

Sex

--

--

--

--

K = Key Field



07

06

06

06

97

1

2

7

2

1

7

No longer effective as of:


12-31-2005

06-30-2010

MMDDYYYY

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10 Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit

A

B

I

K

M

O

P

U

W

Asian

Black or African-American

American Indian

Alaskan Native

Multiracial

Other

Pacific Islander

Unknown

White

Asian

Black or African American

American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other

Alaska Native (Aleut, Eskimo, Indian)

Two or More Races

Other Single Race

Native Hawaiians or Other Pacific Islanders

Unknown

White

Race--

K = Key Field



13

04

02

01

21

20

23

97

05

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10

11

Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit

Hispanic or Latino Origin ( Ethnicity)

A

B

I

O

U

W

C

H

M

N

P

U

Asian or Pacific Islander


American Indian

Other

Unknown

White

Hispanic, Cuban

Hispanic, Other

Hispanic, Mexican American

Not Hispanic, Orgin

Hispanic, Puerto Rican

Unknown

Asian or Pacific Islander use only if not collecting codes separately


American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other

Other Single Race

Unknown

White

Cuban

Other Specific Hispanic

Mexican

Not of Hispanic or Latino Origin

Puerto Rican

Unknown

Race

Ethnicity

--

--

K = Key Field



03

04

02

20

97

05

03

04

02

05

01

97


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12 Education

00

01

02

03

04

05

06

07

08

09

10

11

12

14

16

17

18

20

None, never attended school

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade / high school graduate

Some college

Baccalaureate degree

Post graduate school

Post bachelor's degree

GED

Less Than One Grade Completed

Years of School(Highest Grade) ( General Equivalency Degree, use 12)

















Education Level--

K = Key Field



00

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

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12 Education

30

35

50

80

99

Kindergarten

Associate degree

School for special skills

Technical trade school

Unknown





Unknown

Education Level--

K = Key Field



01-25

01-25

01-25

01-25

97


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12 Education

00

01

02

03

04

05

06

07

08

09

10

11

12

14

16

17

18

20


1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade / high school graduate

Some college


Post graduate school

Post bachelor's degree

GED

Less Than One Grade Completed

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

12th Grade or GED

1st year of College/Iniversity (Freshman)

4th year of College/Iniversity (Senior) or Bachelor's Degree)

Some Post-Graduate Study - Degree not completed

Graduate or Professional school - medical, law - includes Master's and Doctorate

12th Grade or GED

Education Level--

K = Key Field



00

01

02

03

04

05

06

07

08

09

10

11

12

13

16

17

70

12

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12

13

Education

Employment Status

30

35

50

80

81

82

00

01

02

03

04

05

06

07

08

09

Kindergarten

Associate degree



Ungraded

Special education

Unemployed Available for Work

Full Time

Part-Time

Student

Retired

Homemaker

Not in workforce, not avaible for work

Armed Forces/National Guard

Seasonal/Migrant Worker

Unknown

Kindergarten

2nd year of College/Iniversity (Sophomore)

Vocational school - business, technical,secretarial, trade or correspondence

Vocational school - business, technical,secretarial, trade or correspondence

Unknown

Self-contained special education class

Unemployed - looking for work in past 30 days or on layoff from job

Full Time - works 35 or more hours a week- includes military

Part Time - works less tahn 35 hours per week

Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.






Unknown

Education Level

Employment Status

--

--

K = Key Field



73

14

71

71

97

74

03

01

02

04

04

04

04

01

04

97

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13 Employment Status

01

01

02

04

04

04

04

04

97


Full Time

Part-Time

Seasonal/Migrant Worker

Homemaker

Retired

Student

Not in workforce, not avaible for work

Unknown









Unknown

Employment Status--

K = Key Field



01

01

02

04

04

04

04

04

97


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14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)

00

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

None

Alcohol

Crack/Cocaine

Marijuana/Hashish

Heroin

Non Prescription Methadone

Other Opiates and Synthetics

PCP -phencyclidine

Other Hallucinogens

Methamphetamines

Other Amphetamines

Other Stimulants

Benzodiazepine

Other non-BenzodiazepineTranquilizers

Barbiturates

Other Sedatives or Hypnotics

Inhalants

None

Alcohol

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

Heroin

Non-Prescription Methadone


PCP

Hallucinogens

Methamphetamine

Other Amphetamines

Other Stimulants

Benzodiazepines

Other Non-Benzodiazapine Tranquilizers

Barbiturates

Other Non-Barbituate Sedatives or Hypnotics

Inhalants

Major Substances, Primary, Secondary, Tertiary--

K = Key Field



01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

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17

18

19

Over the Counter

Other

Tobacco

Over-the-Counter

Other

Other


K = Key Field



18

20

20

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00

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

None

Alcohol

Crack/Cocaine

Marijuana/Hashish

Heroin

Non Prescription Methadone


PCP

Other Hallucinogens

Methamphetamines

Other Amphetamines

Other Stimulants

Benzodiazepine

Other Tranquilizers

Barbiturates

Other Sedatives or Hypnotics

Inhalants

None

Alcohol

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

Heroin



PCP

Hallucinogens

Methamphetamine

Other Amphetamines

Other Stimulants

Benzodiazepines

Other Non-Benzodiazapine Tranquilizers

Barbiturates

Other Non-Barbituate Sedatives or Hypnotics

Inhalants


K = Key Field



01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

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14

15

Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)

Usual Route of Administration ( Primary-15A, Secondary-15B, Tertiar-15C)

17

18

1

2

3

4

5

9

Over the Counter

Other

Oral

Smoking

Inhalation

Injection

Other

Unknown

Over-the-Counter

Other

Oral

Smoking

Inhalation

Injection (IV or intramuscular, intradermal or subcutaneous)

Other

Unknown

Major Substances, Primary, Secondary, Tertiary

Usual Route of Administration

--

--

K = Key Field



18

20

01

02

03

04

20

97


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16

17

17

Frequency of Use ( Primary-16A, Secondary-16B, Tertiary-16C)

Age of First Use (Primary-17A, Secondary-17B, Tertiary-17C)


0

1

2

3

4

9

00-99

00-99

00-95

96

97

98

99

Drug Not Used During Past Month

Drug Used 1-3 Times in Past Month

Drug Used 1-2 Times per Week

Drug Used 3-6 Times per Week

Drug Used Daily

Unknown

Age at First Use in years







No use in the past month

1-3 times in past month

1-2 times per week

3-6 times per week

Daily

Unknown

Age at First Use, in years

Newborn with a substance dependecy problem






Frequency of Use

Age of First Use

Age of First Use

--

--

--

K = Key Field



01

02

03

04

05

97

01-95

00

01-95

01-95

01-95

01-95

01-95

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K

17

18


Type of Services

00-99

01

02

03

04

05

06

07

08


Detox, 24 Hr Hospital

Detox, 24 Hr Residential

Rehab/Res - Hosp (other than detox)

Rehab/Res - Short Term (30 days or less)

Rehab/Res - Long Term (over 30 days)

Ambulatory - Intensive Outpatient

Ambulatory - Non-Intensive Outpatient

Ambulatory - Detoxification


Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Detoxification Free-standing Residential ( Detox, 24 hour Service)

Rehabilitation/Residential - Hospital (other thandetox)

Rehabilitation/Residential - Short-term, ( 30 days or fewer)

Rehabiliation/Residential - Long-term, ( more than 30 days)



Ambulatory Detoxification

Age of First Use

Type of Service

--

--

K = Key Field



01-95

01

02

03

04

05

06

07

08



08-31-2014

08-31-2014

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K 18

19

Type of Services

Medication-Assisted Opioid Therapy

10

20

30

40

50

60

70

80

LI

LO

PH

RI

1

2









LME Inpatient

LME Service/Procedure Code

State Facility code

Residential Treatment Center

Yes

No

Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Detoxification Free-standing Residential ( Detox, 24 hour Service)

Rehabilitation/Residential - Hospital (other thandetox)

Rehabilitation/Residential - Short-term, ( 30 days or fewer)

Rehabiliation/Residential - Long-term, ( more than 30 days)




other psychiatric inpatient

SMHA funded/operated community based program

State psychiatric hospital

Residential treatment center

Yes

No

Type of Service

Opiod Replacement Therapy

--

--

K = Key Field



01

02

03

04

05

06

07

08

75

73

72

74

1

2


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19 Medication-Assisted Opioid Therapy

N

Y

No

Yes

No

Yes

Opiod Replacement Therapy--

K = Key Field



2

1

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North CarolinaSupplemental

1

4

5

6

Detail Drug Code, Primary

Diagnostic Code (DSM or ICD) field should be coded 999.98 - field 19 replaces i

Psychiatric Problem in Addition to Alcohol or Drug Problem

Pregnant at Admission

999.97

xxx.xx

1

2

7

1

2

6

7

Unknown

ICD-9 Diagnosis Code

Yes

No

Unknown

Yes

No

Male

Unknown

Unknown

DSM/ICD codes

Yes

No

Unknown

Yes - female client was pregnant at admission

No - female client was not pregnant at admission

Not Applicable - use this code for male clients or children in prepuberty age

Unknown

Detailed Drug Code

Diagnostic category group

Psych problem in addition to Alcohol or Drug

Pregnant at admission

~

~

~

~

K = Key Field



999.97

XXX.XX

1

2

7

1

2

6

7

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6

7

Pregnant at Admission

Veteran Status

N

Y

N

U

Y

No

Yes

No

Unknown

Yes

No - female client was not pregnant at admission

Yes - female client was pregnant at admission

No

Unknown

Yes

Pregnant at admission

Veteran Status

~

~

K = Key Field



2

1

2

7

1


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8 Living Arrangements

00

01

02

03

04

05

06

07

08

09

10

11

Unknown

Private Residence

Other independent rooming house

Homeless

Correctional facility

Institution

Residentail Facility, excluding nursing home

Foster Care, Alternative Family Living

Nursing Homes

Adult Care Home

Community ICF-MR 70 or more beds

Community ICF-MR

Unknown

Independent Living - clients living alone or with others but no supervision


Homeless - clients with no fixed address; includes homeless shelter

Dependent Living - clients living in a supervised setting








Living Arrangement~

K = Key Field



97

03

03

01

02

02

02

02

02

02

02

02


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8 Living Arrangements

01

01

02

02

03

04

05

05

06

06

07

07

08

08

09

09

10

10

Private Residence

Private Residence



Homeless


Institution

Institution





Nursing Homes

Nursing Homes

Adult Care Home - 7 or more beds (Rest Home)

Adult Care Home - 7 or more beds (Rest Home)

Adult Care home - 6 or fewer beds (family care home)

Adult Care home - 6 or fewer beds (family care home)


Private residence , living arrangement not specified, adults (temporary code NH






Dependent living: institutional setting (MH only)


Dependent living: residential care (MH only)

Dependent living: foster home/foster care (MH only)








Living Arrangement~

K = Key Field



03

04

04

03

01

02

02

52

02

22

32

02

02

52

22

02

22

02

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8

9

10

11

Living Arrangements

Source of Income/Support

Health Insurance

Expected/Actual Primary Source of Payment

11

11

12

12

-

-

-

Community ICF-MR

Community ICF-MR -

Community ICF-MR 70 or more beds -


Not collected

Not collected

Not collected





Not Collected

Not Collected

Not Collected

Living Arrangement

Source of Income

Health Insurance

Expected source of payment

~

~

~

~

K = Key Field



02

52

52

02

98

98

98

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12

12

13

Detailed Not in Labor Force

Detailed Not in Labor Force

Detailed Criminal Justice Referral Categories

03

04

05

06

01

02

03

04

05

06

07

08

09

-

Not in workforce, Student

Not in workforce, Retired

Not in workforce, Homemaker

Not in workforce

Homemaker

Student

Retired

Disabled

Incarcerated

Other

Armed Forces / National Guard

Seasonal/Maigrant Worker

Unknown

Not collected

Student

Retired

Homemaker

Other

Homemaker

Student

Retired

Disabled

Inmate of Institution ( Prison or Institution - keeps people out of work force)

Other

Other

Other

Unknown

Not Collected

Detailed Not In Labor Force

Detailed Not In Labor Force

Detailed criminal justice referral

~

~

~

K = Key Field



02

03

01

06

01

02

03

04

05

06

06

06

97

98


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14

15

16

Marital Status

Days Waiting to Enter Treatment

Number of Arrests in the 30 Days Prior to Admission

A

D

L

M

P

S

U

W

-

00

01-96

97

Annulled

Divorced

Domestic Partner

Married

Separated

Single (never married)

Unknown

Widowed

Nor collected

None

01-96

Unknown

Never Married - includes clients who are single or whose

Divorced

Now Married ( includes those living together as married)

Now Married ( includes those living together as married)

Separated (legally seperated or otherwise absentbecasue of marital discord))

Never Married - includes clients who are single or whose

Unknown

Widowed

Not Collected

Number of Arrests

Number of Arrests

Unknown

Marital Status

Days waiting to enter treatment

Arrests in 30 days prior to admission

~

~

~

K = Key Field



01

04

02

02

03

01

97

05

998

00-96

00-96

97

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17

18

19

Frequency of Attendance at Self-Help Programs in 30 days prior to Admission

Diagnostic Code Set

Diagnostic Code (ICD-10 Form)

01

02

03

04

05

06

97

2

xxx.xx

No attendance in past month

1-3 times in past month (less than 1 per week)

4-7 times in past month (about 1 per week)

8-15 times in past month (2-3 times perweek)

16-30 times in past month (4+ times perweek)

Some attendance but frequency unknown

Unknown

ICD-9

ICD-9 Code

No Attendance in past month

less than once a week -1 to 3 times in past 30 days

About once a week - 4 to 7 times in past 30 days

2 to 3 times a week - 8 to 15 times in past 30 days

4 or more times a week - 16 to 30 times in past 30 days

Some Attendance in past month, but number of times and frequency is unknown

Unknown

ICD-9

7 digit code

Frequency of attendance at self-help programs

Diagnostic Code Set Identifier

Substance Abuse Diagnosis - ICD-10 Compatible

~

~

~

K = Key Field



01

02

03

04

05

06

97

2

xxx.xxxx

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North CarolinaMental Health Admissions

1

1

1

2

MH Diagnostic Code - a,b,c



SMI/SED

xxx.xx

xxx.xxxx

xxx.xx

xxx.xxxx

xxx.xx

xxx.xxxx

1

2

4

ICD-9 Code

ICD-10

ICD-9 Code

ICD-10

ICD-9 Code

ICD-10

Client has 1 or more SMI Diagnosis

Client has 1 or more SED Diagnosis

Client has 1 or more MH Diagnosis but no SMI/SED

code format...

code format

code format...

code format

code format...

code format

SMI

SED

Not SMI/SED

MH Diagnostic Code - two (ICD-10 Compatible)

MH Diagnostic Code - one (ICD-10 Compatible)

MH Diagnostic Code - three (ICD-10 Compatible)

SMI/SED Status

MHA 1b

MHA 1a

MHA 1c

MHA 2

K = Key Field



XXX.XX

XXX.XXXX

XXX.XX

XXX.XXXX

XXX.XX

XXX.XXXX

1

2

4

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3

3

4

4

School Attendance Status


Legal Status at Admission to State Hospital

Legal Status at Admission to State Hospital

1

2

2

8

98

01

03

04

97

YES, child NOT suspended or expelled from school past 3 months

NO, child suspended and expelled from school past 3 months

NO, child suspended or expelled from school past 3 months

Not collected

Not collected

Voluntary-self

Involuntary-civil

Involuntary-criminal

Unknown

Yes, client has attended school at any time in the past 3 months

No, client has not attended school at any time in past 3 months

No, client has not attended school at any time in past 3 months

Not Collected

Not Collected

Voluntary

Involuntary - civil

Involuntary - criminal

Unknown



Legal Status at Admission to the State Hospital

Legal Status at Admission to the State Hospital

MHA 3

MHA 3

MHA 4

MHA 4

K = Key Field



1

2

2

8

98

01

03

04

97



09-14-2015

09-14-2015

CWMS_PROXY

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5

5

GAF/CGAS Score

GAF/CGAS Score

0-100

997

998

GAF/CGAS Score (only collected at Psych Hospitals for adults)

Unknown

Not collected

Score

Unknown

Not Collected

GAF / CGAS Score

GAF /CGAS Score (discharge)

MHA 5

MHD-6

K = Key Field



0-100

997

998


CWMS_PROXY

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North CarolinaDischarge/NOMS

1

2

3

4

5

6

System Transaction at Discharge

State Code at Discharge

Reporting Date at Discharge

State Provider Identifer at Discharge

Client Identifier at Discharge

Co-Dependent/Collateral at Discharge

A

C

D

2

Add

Change

Delete

Default value - none are collateral

Add

Change

Delete

No

System transaction type

FIPS State code

Month & year data file submitted

Provider ID at discharge

Client ID

Co-dependent/collateral

~~

~~

~~

~~

~~

~~

K = Key Field



A

C

D

2

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7 Type of Treatment Service/Treatment Setting at Discharge

10

20

30

40

50

60

70

80

96

LI

LO

PH

RI

Detox, 24 hr. Hospital Inpatient

Detox, 24 hr. Residential

Rehab/Res - Hosp ( other than detox)


Rehab/Res - Long Term ( over 30 days)


Ambulatory - Non Intensive Outpatient


Not Applicable

LME Inpatient


State Facility Code


Detoxification, 24-Hour Service, Hospital Inpatient

Detoxification, 24-Hour Service, Free Standing Residential

Rehabilation/Residential - Hospital (other than detoxification)

Rehabilation/Residential - Short Term (30 Daysor Fewer)

Rehabilation/Residential - Long Term (More than 30 Days)

Ambulatory - Intensive -Outpatient

Ambulatory -Non Intensive -Outpatient


Not Applicable ( use only for codependents or collateral clients (SA) and for MH

Other psychiatric inpatient


State Psychiatric Hospital


Service at Discharge~~

K = Key Field



01

02

03

04

05

06

07

08

96

75

73

72

74

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7

8

9

Type of Treatment Service/Treatment Setting at Discharge

Date of Last Contact or Data Update

Date of Discharge

01

02

03

04

05

06

07

08

97

Detox, 24 hr. Hospital Inpatient

Detox, 24 hr. Residential

Rehab/Res - Hosp ( other than detox)


Rehab/Res - Long Term ( over 30 days)


Ambulatory - Non Intensive Outpatient


Unknown

Detoxification, 24-Hour Service, Hospital Inpatient

Detoxification, 24-Hour Service, Free Standing Residential

Rehabilation/Residential - Hospital (other than detoxification)

Rehabilation/Residential - Short Term (30 Daysor Fewer)

Rehabilation/Residential - Long Term (More than 30 Days)

Ambulatory - Intensive -Outpatient

Ambulatory -Non Intensive -Outpatient



Service at Discharge

Date of last contact

Date of Discharge

~~

~~

~~

K = Key Field



01

02

03

04

05

06

07

08

72


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10 Reason for Discharge, Transfer, or Discontinuance of Treatment

01

02

03

04

05

06

07

08

Death

Evaluation completed

Treatment completed

Client not available (moved,hospitilized,ill, etc)

Refused treatment (left against advice, dropped out)

No show

Service not available

Other

Death

Other - includes aging out of MH childrens system, extended placement (condition

Treatment Completed


Dropped out of treatment (lost contact, Left Against Professional Advice

Transferred to Trtment Prog or Facil, but did notreport



Reason for Discharge~~

K = Key Field



06

07

01

07

02

14

07

07


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01

02

03

04

05

06

07

08

97

AA

AM

AP

BP

CN

CP

DA

DC

DE

Death

Evaluation completed

Treatment completed

Client not available (moved,hospitilized,ill, etc)

Refused treatment (left against advice, dropped out)

No show

Service not available

Other

Unknown

Against Medical advice Discharge (AMA)

Death w Autopsy - Medical Examinar

Area Program Denial

Behavioral Problem Discharge

Transfer between Certified and Non-Certified Location

Direct discharge completion of program

Direct with Approval

Direct by Court Order

Death w/o Autopsy

Death

Treatment Completed

Treatment Completed



Transferred to Trtment Prog or Facil, but did notreport



Unknown


Death




Treatment Completed

Treatment Completed

Incarerated or released by or to courts

Death


K = Key Field



06

01

01

02

02

14

07

07

97

02

06

07

07

07

01

01

05

06

CWMS_PROXY

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DI

DL

DM

DN

DO

DP

DS

DV

DW

EC

EV

IA

IC

IE

IL

IO

IT

IV

Direct Discharge to Inpatient Commitment

Death while on Leave or Visiting Patient

Direct Discharge to Medical Visit

Physician Denial

Direct to Outpatient Commitment

Diversion to other psychiatric facility

Direct to Substance Abuse Commitment

Direct Discharge of Visiting Patient

Death with Autopsy

Direct D/C to State facility for ECT

Evaluation

Indirect to Substance Abuse Commitment

Transfer to Intermediate Care Facility (ICF)

Indirect Discharge - Expired on Medical Visit

Indirect Discharge from Leave

Indirect to Outpatient Commitment

Internal Transfer - to Medical/Surgery Bed

Indirect Discharge ov Visiting Patient


Death

Discharged from the state hospital to acute medical facility for medical service


Treatment Completed

Transferred to Another Treatment Program or Facility



Death





Death


Treatment Completed

Discharged from the state hospital to acute medical facility for medical service



K = Key Field



07

06

34

07

01

04

04

07

06

04

07

04

04

06

02

01

34

07

CWMS_PROXY

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10

11

12

Reason for Discharge, Transfer, or Discontinuance of Treatment

Provider Identifier at Admission

Client Identifier at Admission

PD

PM

PR

PS

RB

RI

RO

RS

RT

SO

ST

TD

TX

WM

Psychiatric Observation

Permanent Discharge from facility for Medical Reasons

Personal Reasons (discharged w approval - family emergency etc)

Transfer to psychiatric Bed In-house

Direct to Substance Abuse Commitment(new)

Denied Recommend Inpatient Commitment

Deny-Recommend Outpatient Commitment

Denied Recommendation Substance Abuse Commitment

Transfer to RTF bed in-house

72 hours request for Discharge ADATC only

Staffed Out

Therapeutic discharge (patient non-compliant w/o altercation)

Permanent Transfer out to other State facility

Death w/o Autopsy - Medical Examinar














Death

Reason for Discharge

Provider ID

Unique Identifier

~~

--

--

K = Key Field



07

07

07

07

04

07

07

07

07

07

07

02

04

06

CWMS_PROXY

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13

14

15

Co-Depentent/Collateral at Admission

Client Transaction Type (pulled from admission dataset)

Date of Admission (pulled from admission dataset)

2

A

M

T

X

No co-dependent or collateral records in data

Initial Admission

Initial admission (MH)

Transfer/Change in Service


Client

Initial Admission (SA)

Initial Admission (MH)

Transfer or change in service (SA)


Codependent/Collateral Data

Client transaction type

Date Admitted

--

--

--

K = Key Field



2

A

M

T

X

MMDDYYYY

CWMS_PROXY

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16

17

Type of Service at Admission (pulled from admission dataset)

Date of Birth (pulled from admission dataset)

10

20

30

40

50

60

70

80

LI

LO

PH

RI









LME Inpatient


State Facility code


Detoxification, 24-hour service - Hospital Inpatient

Detoxification , 24 hour service , Free-StandingResidential

Rehabilitation/Residential - Hospital (other thanDetoxification)

Rehabilitation/Residential - Short Term (30 days or fewer)

Rehabilitation/Residential - Long Term (more than 30 days)




Other pscyhiatric inpatient




Type of Service

Date of birth

--

--

K = Key Field



01

02

03

04

05

06

07

08

75

73

72

74

MMDDYYYY

CWMS_PROXY

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18

19

Gender (pulled from admission dataset)

Race (pulled from admission dataset)

1

2

7

A

B

I

K

M

O

P

U

W

Male

Female

Unknown

Asian


American Indian

Alaskan Native

Multiracial

Other

Pacific Islander

Unknown

White

Male

Female

Unknown

Asian


American Indian

Alaskan Native (Aleut, Eskimo)

Two or more races

Other single race

Native Hawaiian or other Pacific Islander

Unknown

White

Sex

Race

--

--

K = Key Field



1

2

7

13

04

02

01

21

20

23

97

05

CWMS_PROXY

Crosswalk Report

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20 Ethnicity (pulled from admission dataset)

C

H

M

N

P

U

Hispanic, Cuban

Hispanic, Other

Hispanic, Mexican American

Not Hispanic, Orgin

Hispanic, Puerto Rican

Unknown

Cuban

Other Specific Hispanic or Latino

Mexican

Not of Specific Hispanic or Latino Origin

Puerto Rican

Unknown

Ethnicity--

K = Key Field



03

04

02

05

01

97

CWMS_PROXY

Crosswalk Report

of 57


21 Substance Problem At Discharge, (Primary, Secondary, Tertiary)

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

None

Alcohol

Cocaine/Crack

Marijuana/Hashish

Heroin

Non-prescription Methadone

Other Opiates/Opiods

PCP

Other hallucinogens

Methamphetamine

Other amphetamines

Other stimulants

Benzodiazepine

Other non-Benzodiazepine tranquilizers

Barbiturates

Other non-barbiturate sedatives or hypnotics

Inhalants

Over-the-counter

None

Alcohol

Cocaine/Crack

Marijuana/Hashish

Heroin



PCP- phencyclidine

Hallucinogens

Methampetamine/SPeed

Other Amphetamines

Other Stimulants

Benzodiazepines

Other Tranquilizer

Barbiturates

Other Sedatives or Hypontics

Inhalants

Over-The-Counter medicines

Substance Problem at Discharge~~

K = Key Field



01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

CWMS_PROXY

Crosswalk Report

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21

22

Substance Problem At Discharge, (Primary, Secondary, Tertiary)

Frequency of Use at Discharge (Primary, Secondary, Tertiary)

20

97

01

02

03

04

05

97

Other

Unknown

No use in past month

1-3 times in past month

1-2 times in past week

3-6 times in past week

Daily

Unknown

Other

Unknown

No Use in the Past Month

1-3 Times in the Past Month

1-2 Times in the Past Week

3-6 Times in the Past Week

Daily

Unknown

Substance Problem at Discharge

Frequency of use at discharge

~~

~~

K = Key Field



20

97

01

02

03

04

05

97

CWMS_PROXY

Crosswalk Report

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23 Living Arrangements at Discharge

00

01

02

03

04

05

06

07

08

09

10

11

12

Unknown

Private residence


Homeless


Institution

Residential facility excluding nursing home

Foster care, alternative family living

Nursing home

Adult care home - 7 or more beds (Rest home)

Adult care home - 6 or fewer beds (family care home)

Community ICF-MR


Unknown













Living arrangement at discharge~~

K = Key Field



97

03

03

01

02

02

02

02

02

02

02

02

02


CWMS_PROXY

Crosswalk Report

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23 Living Arrangements at Discharge

00

01

01

02

02

03

04

05

05

06

06

07

07

08

08

09

09

10

Unknown

Private residence

Private residence



Homeless


Institution

Institution





Nursing home

Nursing home




Unknown











Dependent living: foster home/foster care (MH only)







Living arrangement at discharge~~

K = Key Field



97

04

03

04

03

01

02

02

52

22

02

32

02

52

02

22

02

22

CWMS_PROXY

Crosswalk Report

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23

24

Living Arrangements at Discharge

Employment at Discharge

10

11

11

12

12

00

01

02

03

04

05

06

07

08

09


Community ICF-MR

Community ICF-MR -


Community ICF-MR 70 or more beds -

Unemployed

Employed full time

Employed part time

Not in work force - student

Not in work force - retired

Not in work force - homemaker

Not in work force - not available for work

Armed forces, National Guard

Seasonal/Migrant worker

Unknown






Unemployed - looking for work in past 30 days or on layoff from job









Unknown

Living arrangement at discharge

Employment status at discharge

~~

~~

K = Key Field



02

02

52

02

52

03

01

02

04

04

04

04

01

04

97

CWMS_PROXY

Crosswalk Report

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25

26

Detailed Not In Labor Force at Discharge

Number of Arrests in 30 Days Priorto Discharge

01

02

03

04

05

06

07

08

09

00

01-96

97

Homemaker

Student

Retired

Disabled

Incarcerated

Other


Seasonal/Migrant worker

Unknown

None

Number of arrests

Unknown

Homemaker

Student

Retired

Disabled

Inmate of Institution ( Prison or Institution - keeps people out of work force)

Other

Other

Other

Unknown

Number of Arrests

Number of Arrests

Unknown

Detailed not in labor force

Arrests in 30 days prior to discharge

~~

~~

K = Key Field



01

02

03

04

05

06

06

06

97

00-96

00-96

97

CWMS_PROXY

Crosswalk Report

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27

28

Frequency of Attendance at Self-Help program in the 30 Days Prior to Discharge

Client Transaction Type - Discharge

01

02

03

04

05

06

97

D

E

U

No attendance in past month

1-3 times in past month (less than 1 per week)

4-7 times in past month (about 1 per week)

8-15 times in past month (2-3 times perweek)

16-30 times in past month (4+ times perweek)

Some attendance but frequency unknown

Unknown

Discharge (SA Client)

Discharge (MH Client)

Data Update (MH client)

No Attendance in past month

Less than once week - 1-3 times in past 30 days

About once a week - 4-7 times in the pastt 30 days

2 to 3 times a week - 8 to 15 times in past 30 days

4 or more times a week - 16 to 30 times in past 30 days

Some Attendance in past month, but number of times and frequency is unknown

Unknown

Discharge (SA)

Discharge (MH)

Update (MH)

Frequency of attendance at self-help programs ..

Client Transaction Type

~~

~~

K = Key Field



01

02

03

04

05

06

97

D

E

U

CWMS_PROXY

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North CarolinaMental Health Discharge

1

2

2

2

Diagnostic Code Set Identifier

MH Diagnostic Code a,b,c



2

3

xxx.xx

xxx.xxxx

xxx.xx

xxx.xxxx

xxx.xx

xxx.xxxx

ICD-9

ICD-10

ICD-9 Code

ICD-10

ICD-9 Code

ICD-10

ICD-9 Code

ICD-10

ICD-9

ICD-10

Code type....

Code type

Code type....

Code type

Code type....

Code type

Diagnostic Code Set Identifier (discharge)

MH Diagnostic Code - two (ICD-10 Form)

MH Diagnostic Code - one (ICD-10 Form)

MH Diagnostic Code - three (ICD-10 Form)

MHD-1

MHD-2b

MHD-2a

MHD-2c

K = Key Field



2

3

XXX.XX

XXX.XXXX

XXX.XX

XXX.XXXX

XXX.XX

XXX.XXXX

CWMS_PROXY

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3

4

SMI/SED - Discharge

School Attendance

1

2

4

1

2

2

8

Client has 1 or more SMI Diagnosis

Client has 1 or more SED Diagnosis

Client has 1 or more MH Diagnosis but no SMI/SED Diagnosis

Yes - not suspended or expelled

No - suspended or expelled

No - suspended and expelled

Not collected

SMI

SED

Not SMI/SED

Yes, client has attended school at any time in the last 3 months

No, client has not attended school at any time in the last 3 months

No, client has not attended school at any time in the last 3 months

Not Collected

SMI/SED Status (discharge)

School Attendance Status (discharge)

MHD-3

MHD-4

K = Key Field



1

2

4

1

2

2

8

CWMS_PROXY

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5 Education/Grade level - MH

00

01

02

03

04

05

06

07

08

09

10

11

12

14

16

17

18

20


First grade

Second grade

Third grade

Fourth grade

Fifth grade

Sixth grade

Seventh grade

Eighth grade

Ninth grade

Tenth grade

Eleventh grade

Twelfth grade / high school graduate

Some College


Post Graduate school

Post Bachelor's degree

GED

less than one school grade or no schooling

Grade 1`

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

12th grade or GED

1st year college

4th year college or Bachelor's Degree

Some Postgraduate Study - Degree not completed

Graduate or Professional School

12th grade or GED

Education /Grade Level (discharge)MHD-5

K = Key Field



00

01

02

03

04

05

06

07

08

09

10

11

12

13

16

17

70

12

CWMS_PROXY

Crosswalk Report

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5

6

Education/Grade level - MH

GAF/CGAS score - MH (optional)

30

35

50

80

81

82

998

Kindergarten

Associate Degree



Ungraded (not educated in typical manner - mentally impaired, elderly)

Special Education

Not collected

Kindergarten

2nd year college or Associate's Degree

Vocational School

Vocational School

Unknown

self-contained special education class

Not Collected

Education /Grade Level (discharge)

GAF / CGAS Score

MHD-5

MHA 5

K = Key Field



73

14

71

71

97

74

998

REPORT CROSSWALK TO STATE

Crosswalk Management System

End of Report

crosswalk management system - dasis home page · k = key field item notreatment episode data set...

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