DRAFT

Summary List

September 3, 1998

 

 

I. CLIENT MASTER DATA ELEMENTS
(Data reported once but may be corrected as needed.)
1. Client Unique Identifier 2. Gender 3. Date of Birth
4. Ethnicity (check all that apply) 5. Hispanic Origin 6. Primary Language
7. English Proficiency 8. Accommodation Needed 9. Veteran Status

 

CLIENT ELIGIBILITY DATA ELEMENTS
(eligibility criteria would vary by contract)
1. Payors 2. Eligibility Status 3. Enrollment Begin Date
4. Enrollment Ending Date 5. Disenrollment Reasons  

 

CLIENT PERIODIC DATA ELEMENTS
(Data collected at specific intervals: admission, every 6 months, annually, and/or discharge.)
1. Education 2. Employment Status 3. Type of Employment
4. Residential Arrangement 5. Household Composition 6. Residence
7. Functional Status 8. Self-reported Health Status 9. Custody/Guardianship/ Conservatorship
10. Legal Status 11. Interagency Participation in Assessment and Provision of Services 12. Marital Status
13. Citizenship (Alien Status) 14. Informed Consent for Treatment 15. Informed Consent for Data Sharing (Release of Information)
16. Presenting Problem(s) at Time of Admission 17. Referring Source 18. First Behavioral Health Diagnosis
19. Second Behavioral Health Diagnosis 20. Additional Mental or Physical Health Diagnosis (1) 21. Additional Mental or Physical Health Diagnosis (2)
22. Additional Mental or Physical Health Diagnosis (3) 23. Primary Care Physician  

 

CLIENT ELEMENTS
(Considered but Not Included.)

    1. Coded area of Residence Prior to Admission to Organization

 2. Chronicity of Mental Illness

    3. History of Use of Mental Health Services Prior to Most Recent Admission to the Organization
4. Referral Upon Discontinuation

    5. Current Primary Therapist or Case Manager

 6. Duration of Disability

    7. Annual Gross Income and Number of Dependents

 8. Income-Principal Source 9. Enrollment Status

    10. Family/caregiver Participation in MH Assessment and Treatment

 11. Inclusion in Treatment Plan  

 

CHILDREN’S ELEMENTS
(Elements Considered but Not Included.)
1. History of Use of MH Services 2. Referral Upon Discontinuation 3. Staff Member(s) Participating

    4. Average Age of Receivable, by Payor Source

    

 

VI. ENCOUNTER DATA ELEMENTS
(Data reported at every encounter; phone, face-to-face; collateral.)
1. Client Unique Identifier 2. Service Transaction Identifier 3. Organization Identifier

    4. Provider Identifier

 5. Type of Service 6. Service Begin Date
7. Service Ending Date 8. Date of Service 9. Location of Service
10. Unit of Service 11. Unit of Time

    12. First Behavioral Health Diagnosis

    13. Second Behavioral Health Diagnosis

 14. Disenrollment Disposition 15. Disposition of Encounter

    16. Presence of Other Staff Members

    

 

ENROLLMENT AND ENCOUNTER ELEMENTS
(Considered but Not Included.)
1. Psych. ER Visits for Non-Emergency 2. Residential Placement 3. Principal Procedures
4. Other Procedures 5. Dates of Procedures 6. Attending Physician Identification (inpatient)
7. Date Payment Made 8. Admitting Service 9. Employee Home Phone
10. Visits During Office Hours 11. Benefits Currently Used 12. Date of Referral
13. Type of Referral 14. Daily Activity Code 15. Service Hours and Days of Operation
16. Dependent Birthdays 17. Dependent Gender 18. Patient’s Relationship to Subscriber/Enrollee
19. Number of Visits for Each Client 20. Total Amount Paid 21. Staff Member(s) Reporting
22. Persons Involved in Event 23. Scheduled Event 24. Medical Record Number
25. Client’s Expected Sources of Payment 26. Authorized Service 27. Authorized Units
28. Medications Prescribed    

 

PROVIDER/ORGANIZTION DATA ELEMENTS
(Data reported once but may be corrected as needed.)
1. Provider Identification 2. Organization Identifier 3. Provider Location
4. Type of Facility    

 

PROVIDER/ORGANIZATION PERIODIC DATA ELEMENTS
(Data reported annually.)
1. Provider Identification 2. Organization Identification

    3. Reporting Year

 

ORGANIZATION ELEMENTS
(Considered but Not Included.)
1. Name of Director 2. Telephone Number of the Director

    3. Location of Directly Operated Service Sites
4. Type of Ownership/Control 5. University/College Affiliation 6. Total Revenue and Support
7. Total Expenses

    8. Number of Hours of Operation Scheduled Per Week

    9. Relation to the State Mental Health Agency
10. Admissions

    11. Discontinuations

 12. Number of Hot-line Phone Calls

    13. Total Full Time Equivalents by Type of Service

    14. Number of Clients on Rolls by Type of Service

    15. Number of Beds Set Up and Staffed by Type of Service

    16. Number of Client Days/Units Provided by Type of Service

    

 

HUMAN RESOURCES DATA ELEMENTS
(Data reported once but may be corrected as needed.)
1. Organization Identifier 2. Provider Identification 3. Staff Unique ID
4. Staff’s Date of Birth 5. Staff’s Gender 6. Staff’s Ethnicity
7. Staff’s Hispanic Origin 8. Date of Employment/Affiliation 9. Discipline/Training/Profession
10. Highest Degree/Education Level 11. License/Certification 12. Employment/Affiliation Status
13. Languages Other Than English 14. Total Full Time Equivalents by Discipline/Training Profession 15. Separation Date

 

HUMAN RESOURCES ELEMENTS
(Considered but Not Included.)
1. Country of Highest Degree 2. Private Practice Maintained 3. University/College Affiliation

    4. Participation in Job-Related or Career Development Training

 5. Income from the Organization 6. Fringe Benefits Value

    7. Year of Degree

 8. Primary Job Function 9. Experience

 

FINANCIAL ELEMENTS
(Data reported annually.)
1. Organization Identifier 2. Provider Identification 3. Current Assets
4. Non-current Assets 5. Total Assets 6. Current Liabilities
7. Non-current Liabilities 8. Total Liabilities

    9. Operating Revenue and Support: First- and Third-Party Revenue by Program Element

    10. Operating Revenue and Support: All Other Sources

    11. Non-operating Revenue and Support

    12. Total Revenue and Support

    13. In-kind Contribution and Volunteers (Value)

 14. Expenses by Program Element

    15. Organization-Level Expenses

    16. Other Expenses at the Organization Level