| Satellite Code |
Display - An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. |
| Client ID |
Display - The Client ID and name as reported on the Client's Demographic Information |
| Status |
Display - Indicates the status of the Mental Health Information record.
PENDING - The record has not been submitted to DHS.
SUBMITTED - The record has been submitted to DHS and is awaiting results.
ACCEPTED - The record has been approved.
REJECTED - The record has been rejected by DHS with an error.
INCOMPLETE - The record has not been updated to include the new client case information. |
| Registration Date |
Mandatory - Date on which the client was registered with the agency. This is the date of the first billable or reportable service event or intake interview with the client, parent, or guardian.
Format: MMDDYYYY
MM = month
DD = day
YYYY = century and year |
| MH CILA Enrollment |
Mandatory - Designates whether the client is enrolled in the MH CILA program.
N - Not applicable
Y - Enrolled in MH CILA |
| Household Composition |
Mandatory - The client's household composition.
10 - Lives alone
20 - Lives with one or more relatives (e.g., biological, step, or adoptive relationships)
30 - Lives with non-related persons (e.g., professional child care staff and other children in group care, foster parents and other foster children)
99 - Unknown |
| Residential Arrangement |
Mandatory - Describes the client's primary residential situation at the present time while services are being initiated or provided.
10 - Homeless (e.g., living on the street, in an emergency shelter, or transient)
21 - Private residence (e.g., structure with accommodations for sleeping in which some individual knowingly owns or rents for the
purpose of housing the client)
- client supervised (not considered to be living independently)
22 - Private residence (e.g., structure with accommodations for sleeping in which some individual knowingly owns or rents for the
purpose of housing the client)
- client unsupervised (considered to be living independently)
31 - Other residential setting (e.g., group homes, half-way houses, supported living situations)
- client supervised (not considered to be living independently)
32 - Other residential setting (e.g., group homes, half-way houses, supported living situations)
- client unsupervised (considered to be living independently)
40 - State-Operated Facility (Mental Health Center or Developmental Center)
50 - Jail or correctional facility/institution (e.g., detention centers, institutions/ training schools)
60 - Other institutional setting (e.g., psychiatric, VA, or community hospitals, residential treatment centers, nursing homes, intermediate care facilities)
80 - Boarding School
90 - Other
99 - Unknown |
| Family Household Size |
Mandatory - The total number of the client's family members in the household, including the client.
NOTE: A family includes a householder and one or more people living in the same household who are related to the householder by birth, marriage, or adoption. All people in the household who are related to the householder are regarded as members of his or her family. A family household may contain people not related to the householder, but those people are not included as part of the householder's family.
Range: 01 - 99
(99 = Unknown) |
| Household Income |
- Mandatory - The total income of all family members in the client's household.
NOTE: ''Total Income'' is the sum of the amounts reported separately for wages, salary, commissions, bonuses, or tips; self-employment income from own non-farm or farm businesses, including proprietorships and partnerships; interest, dividends, net rental income, royalty income, or income from estates and trusts; Social Security or Railroad Retirement income; Supplemental Security Income (SSI); any public assistance or welfare payments from the state or local welfare office; retirement, survivor, or disability pensions; and any other sources of income received regularly such as Veterans' (VA) payments, unemployment compensation, child support, or alimony.
Range: 000000 - 999999
(999999 = Unknown)
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| Client Income |
Mandatory - The total income of the client. See definition of ''Total Income'' above.
Range: 000000 - 999999
(999999 = Unknown) |
| Diagnosis Type |
Removed. No longer required. |
| Principal Diagnosis |
Removed. No longer required. |
|
Diagnosis Information
Diagnosis Code 1
Diagnosis Code Type 1
Diagnosis Code 2
Diagnosis Code Type 2
Diagnosis Code 3
Diagnosis Code Type 3
Diagnosis Code 4
Diagnosis Code Type 4
Diagnosis Code 5
Diagnosis Code Type 5
Diagnosis Code 6
Diagnosis Code Type 6
Diagnosis Code 7
Diagnosis Code Type 7
Diagnosis Code 8
Diagnosis Code Type 8
Diagnosis Code 9
Diagnosis Code Type 9
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Mandatory - Describes the major mental illnesses or developmental disabilities for which the client is seeking or receiving services. Report any valid diagnosis code for the following fields.
Diagnosis Code 1 -- 9
Report ICD-9-CM for Case openings on or before September 30, 2015.
(International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM)
Report ICD-10-CM for Case openings on or after October 1, 2015.
International Classification of Diseases, 10th Revision Clinical Modification (ICD-10-CM))
Diagnosis Code Type 1 -- 9 -- Report 'A' for ICD-10 diagnosis codes, report '9' for ICD-9 diagnosis codes.
NOTE: Federal and state laws prohibit the disclosure of specific HIV diagnoses and thus, these diagnoses should not be reported on registration. Specific codes should be entered from the official ICD-9-CM Diseases: Tabular List (Volume 1) or Alphabetical List (Volume 2). These are published yearly by the U.S. Department of Health and Human Services, the American Medical Association, or St. Anthony's Press. Additional information may be obtained from the diagnosing clinician. In rare
instances where the specific code for the diagnosis is not known enter the code(s) from the list below which best reflects the broader applicable diagnostic category.
********************************************* NOTE *****************************************************************
The 'XX' indicates where the sub classification of the diagnosis code should be entered. DO NOT ENTER the 'XX''. Enter the exact diagnosis code.
*******************************************************************************************************************************
001XX - Infectious and Parasitic Diseases 140XX - Neoplasms
240XX - Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders
280XX - Diseases of the Blood and Blood-Forming Organs
303XX - Alcohol Dependence Syndromes 304XX - Drug Dependence Syndromes
320XX - Diseases of the Circulatory System 343XX - Infantile Cerebral Palsy
345XX - Epilepsy
369XX - Blindness and Low Vision 389XX - Hearing Loss (or impairment)
390XX - Diseases and the Circulatory System
460XX - Diseases of the Respiratory System
520XX - Diseases of the Digestive System
580XX - Diseases of the Genitourinary System
630XX - Complications of Pregnancy, Childbirth, and the Puerperium
680XX - Diseases of the Skin and Subcutaneous Tissue
710XX - Diseases of the Musculoskeletal System and Connective Tissue
740XX - Congenital Anomalies
760XX - Certain Conditions Originating in the Perinatal Period
780XX - Symptoms, Signs, and Ill-Defined Conditions
800XX - Injury and Poisoning
|
| Diagnosis Information |
Mandatory - Current functioning scale score as assessed in the registration process. GAF scores are to be obtained by rating the adult's current level of functioning (i.e., within the past week), while CGAS scores are to be obtained by rating the child's or adolescent's most impaired level of general functioning over the previous month.
GAF/CGAS Score: Valid Values: 01-99
Scale Used - Mandatory - The functional scale used.
C - Children's Global Assessment Scale (CGAS)
G - Global Assessment of Functioning (GAF)
NOTE: Scale selection will prescribe which client functioning information should be reported. If CGAS scale is used - report the Child Adolescent section for Client Functioning; if GAF scale is used - report the Adult section for Client Functioning.
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| Client Functioning - Adult |
Mandatory - Use these fields when the GAF scale is used for Axis V Diagnosis Information. If CGAS scale is used, this section is not used, leave these fields blank.
Determination of impairment criteria for adults.
Report one of the following codes for each impairment category.
0 - Client does not meet serious impairment criteria
1 - Client meets serious impairment criteria
Social Group / School: Client has serious impairment in social, occupational, or school functioning.
Employment: Client is unemployed or working only part-time due to mental illness and not for reasons of physical disability or some other role responsibility (e.g., student or primary care giver for dependent family member); is employed in a sheltered setting or supportive work situation, or has markedly limited work skills.
Financial: Client requires help to seek public financial assistance for out-of-hospital maintenance (e.g., Medicaid, SSI, SSDI, other indicators).
Community Living: Client does not seek appropriate supportive community services, (e.g., recreational, educations, or vocational support services), without assistance.
Supportive Social: Client lacks supportive social systems in the community (e.g., no intimate or confiding relationship with anyone in their personal life, no close friends or group affiliations, is highly transient or has inability to co-exist within family setting).
Daily Living: Client requires assistance in basic life and survival skills (e.g., must be reminded to take medication, must have transportation to mental health clinic and other supportive services, needs assistance in self-care, household management, food preparation or money management, etc., is homeless or at risk of becoming homeless).
Dangerous Behavior: Client exhibits inappropriate or dangerous social behavior which results in demand for intervention by the mental health and/or judicial/legal system.
Previous Impairment: Currently receiving mental health treatment, has a history within the past five years of functional impairment meeting two of the functional criteria listed above which persisted for at least 12 months, and there is documentation supporting the professional judgement that regression in functional impairment would occur without continuing treatment.
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Client Functioning - Child & Adolescents
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Mandatory - Use these fields when the CGAS scale is used for Axis V diagnosis information. If the GAF scale is used, this section is not used, leave these fields blank.
Determination of impairment criteria for children and adolescents. Report one of the following codes for each impairment category.
0 - Client does not meet serious impairment criteria
1 - Client meets serious impairment criteria
Self Care: Consistent inability to take care of age appropriate personal grooming, hygiene, clothes and meeting of nutritional needs.
Community: Consistent lack of age appropriate behavioral controls, decision-making, judgement, and value systems which result in potential involvement or involvement of the juvenile justice system.
Social Relations: Consistent inability to develop and maintain satisfactory relationships with peers or adults.
Family Relations: A pattern of disregard for safety and welfare of self or others (e.g., fire setting, serious and chronic destructiveness), significantly disruptive behavior exemplified by repeated and/or unprovoked violence to siblings and/or parents or inability to conform to reasonable limitations and expectations. The degree of impairment requires intensive (i.e., beyond age appropriate) supervision by parent/care giver and may result in removal from family or its equivalent.
School: Inability to pursue educational goals in a normal time frame (e.g., consistently failing grades, repeated truancy, expulsion, property damage or violence towards others) that cannot be remedied by a classroom setting (whether traditional or specialized).
|
| Functional Impairment - Adults |
Optional - Use this section is the Multnomah Community Ability Scale (MCAS) was used.
NOTE: Consult the MCAS instrument for full descriptions of each item. Staff using the MCAS must be trained by a DMH approved trainer.
Determination of functional impairment criteria for adults. Report the appropriate rating for each MCAS domain.
Domains 1 - 13 and 15 - 17
Range: 1 - 5
9 Unknown
Domain 14
Range: 0 - 5
9 Unknown
Physical Health - Impairment of client by his/her physical health status.
Intellectual Functioning - General intellectual functioning
Thought Process - Impairment as evidenced by symptoms such as hallucinations, delusions, tangentiality, etc.
Mood Abnormality - Impairment as evidenced by such symptoms as constricted mood, extreme mood swings, etc.
Response to Stress and Anxiety - Impairment as evidenced by inappropriate and/or stressful events, etc.
Ability to Manage Money - Successfulness of ability of client to manage his/her money and control expenditures.
Independence in Daily Life - Ability to perform independently in day-to-day living.
Acceptance of Illness - How well client accepted his/her psychiatric disability.
Social Acceptability - Other people's reactions to the client.
Social Interest - Frequency with which client initiates social contracts or responds to other's initiation of contact.
Social Effectiveness - Effectiveness of client's interaction with others.
Social Network - Extensiveness of client's social support network.
Meaningful Activity - Frequency with which client is involved in meaningful activities that are satisfying to him/her.
Medication Compliance - Frequency with which client complies with his/her medication regimen.
Cooperation with Treatment Providers - Frequency with which client cooperates with providers (for example, keeping appointments, complying with treatment plan, etc.).
Alcohol/Drug Abuse - Frequency with which client abuses drugs/alcohol.
Impulse Control - Frequency of episodes of acting out (e.g., temper outbursts, spending sprees, aggressive actions, etc.).
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| Functional Impairment - Children & Adolescents |
Optional - Use this section is the Child and Adolescent Functional Assessment Scale (CAFAS) was used.
NOTE: Consult the CAFAS instrument for full descriptions of each item. The CAFAS is copyrighted. Staff using the CAFAS must be trained by a DMH approved trainer.
Determination of functional impairment criteria for children and adolescents. Report the appropriate rating for each CAFAS domain.
Range: 00 - 30
99 Could Not Rate
School/Work - Extent to which child/adolescent meets performance expectations of school/work.
Home - Extent to which self-care is appropriate and household chores are performed satisfactorily.
Community - Extent to which child/adolescent community role performance is satisfactory.
Behavior Towards Others - Extent to which behavior towards others is impaired.
Mood/Emotion - Extent to which expression of feelings or control is impaired.
Self-Harm Behavior - Extent to which child/adolescent displays behavior that is harmful to self (e.g. resulting in pain or injury).
Substance Use - Impairment due to the use of alcohol/drugs.
Thinking - Impairment in thought process.
Care-Giver Resources:
Material Needs - Extent to which care-giver provides for child/adolescent basic needs (e.g. housing, food, etc.)Family/Social Support - Extent which adequate resources exist to care for child/adolescent.
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| History of Illness/Disability |
Mandatory - Determination of the client's previous contacts with elements of the mental health delivery system. Report one of the following codes for each category.
0 - Client does not meet treatment history criteria
1 - Client meets treatment history criteria
Continuous Treatment: Continuous treatment of six months or more in one or a combination of the following treatment modalities: inpatient treatment; day treatment; partial hospitalization.
Continuous Residential: Six months continuous residence in residential treatment programming.
Multiple Residential: Two or more admissions to inpatient treatment, day treatment, partial hospitalization or residential treatment programming within a 12 month period.
Outpatient: History of using the following outpatient services over a one year period, whether continuously or intermittently: psychotropic medication management; case management; outreach and engagement services, including SASS and intensive community-based services.
Previous Treatment: Previous treatment in an outpatient modality and a history of at least one mental health psychiatric hospitalization.
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| Co-Occurring Disorders |
Mandatory - Indicates whether or not the client has been screened for co-occurring mental illness/substance abuse disorders.
Y - YES
N - NO |
| Justice System Involvement |
Mandatory - Describes the client's criminal justice system involvement at the time of case registration.
NOT APPLICABLE
ARRESTED
CHARGED WITH A CRIME
INCARCERATED (JAIL)
INCARCERATED (PRISON)
JUVENILE DETENTION CENTER
OTHER
UNKNOWN |
| Discharge-Linkage-Aftercare/Triage Information |
- The date on which the client was discharged from the State Operated Facility or the date of triage.
- FORMAT: MMDDYYYY
YYYY - Century and year
MM - Month
DD - Day
The location of the first face to face meeting with the client or the reason a meeting did not take place upon discharge from the State Operated Facility.
Meeting Locations:
01 - At Client Home/Residence
02 - At Agency
03 - At State Hospital
04 - At Other Location
Reasons for No Meeting:
10 - Client Not Located
11 - Client Refused Contact with Agency
12 - Client Moved Out of Service Area
13 - Client in Jail/DOC
14 - Client Readmitted to SOF
15 - Access to Client Denied by Resid. Fac.
19 - Other
99 - Unknown
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MH Cross Disabilities Database Information
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Date Form Completed: The date on which the MH cross disabilities database form was completed.
Age of Primary Care Giver: The age of the primary care giver.
Range: 18-98
00 - Not Applicable
99 - Unknown
Type of Services Needed: Describes the type of services needed by the client as determined by the assessment staff:
- Residential/Living Arrangement
- Vocational Rehabilitation
- Transportation
- Medical
- Substance Abuse Treatment
- MH Case Management
- Hospitalization
- Other
- Unknown
Type of Services Needed - Other Description: Specifies the type of services needed when Other is selected.
Type of Services Sought: Describes the type of services sought by the client as determined by the consumer:
- Not Applicable
- Residential/Living Arrangement
- Vocational Rehabilitation
- Transportation
- Medical
- Substance Abuse Treatment
- MH Case Management
- Hospitalization
- Other
- Unknown
Type of Services Sought - Other Description: Specifies the type of services sought when Other is selected.
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| MH Closing Information |
Leave blank if the client is active.
- Closing Date: Mandatory - When closing the Client MH Information, report the closing date.
Format: MMDDYYYY
MM = month
DD = day
YYYY = century and year
GAF/CGAS Score At Closing: Mandatory - Current functioning scale score as assessed at the time of the case closing process. GAF scores are to be obtained by rating the adult's current level of functioning (i.e., within the past week at last contact), while CGAS scores are to be obtained by rating the child's or adolescent's most impaired level of general functioning over the previous month of the last contact.
Valid Values: 00 - 99
Scale Used for Closing: Mandatory - The functional scale used at closing.
C - Children's Global Assessment Scale (CGAS)
G - Global Assessment of Functioning (GAF)
Closing Disposition: Mandatory - Describes the disposition of the client at the point he/she stops receiving services.
01 - Deceased
02 - Completed treatment: client no longer needs services from this provider
03 - Refused treatment: client refuses further treatment from this provider
04 - Transfer: client has been transferred to another community provider, including providers of mental health or developmental disability services, substance abuse treatment, general social services, hospital outpatient services, or other medical care
05 - Moved: client/guardian from service area/out of state, with no transfer to another provider
06 - Transfer to Long Term Care provider setting (ICFDD, IMD, VA inpatient hospital)
07 - Transfer to State-Operated facility
08 - Incarcerated
90 - Other: Includes discharge of long-term inactive clients and of persons who have been lost to contact
99 - Unknown
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| Submit Date |
Display - The date on which the record was submitted to DHS for processing. |
