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/Dimension5 | Version: 1.0.0 | |||
| Draft as of 2022-08-31 | Computable Name: | |||
Justification for level of care score (see ServiceRequest) in Dimension 5
Generated Narrative: Questionnaire Dimension5
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | Justification for level of care score (see ServiceRequest) in Dimension 5 | Questionnaire | https://fhir.njsams.rutgers.edu/NJSAMS-fhir/Questionnaire/Dimension5#1.0.0 | |
  LOCI3Dimension5 | null | 0..1 | group | |
  Level0.5 | LEVEL 0.5 - Early Intervention | 0..1 | group | |
  LOCI3Dimension5.Level0.5.D5Level0_5EIa | a. Does not understand the need to alter current behavior or pattern of use of alcohol, tobacco, and/or other drugs to prevent harm that may be related to such use or behavior; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level0.5.D5Level0_5EIb | b. Needs to acquire specific skills needed to change current pattern of use or behavior. | 0..1 | boolean | |
| Level1_Services | Level 1- Outpatient Services | 0..1 | group | |
| LOCI3Dimension5.Level1_Services.D5Level1OPa | a. Able to achieve or maintain abstinence and related recovery goals. Or able to achieve awareness of a substance or other addiction problem and related motivational enhancement goals, only with support and scheduled therapeutic contact. | 0..1 | boolean | |
| Level1_Enhanced | Level 1- Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level1_Enhanced.D5Level1DDEa | a. Able to achieve or maintain mental health functioning and related goals only with support and scheduled therapeutic contact. Unstable and requires outreach and support of assertive community treatment and intensive case management to maintain mental health function. | 0..1 | boolean | |
| Level2.1_Services | LEVEL 2.1 - Intensive Outpatient Services | 0..1 | group | |
| LOCI3Dimension5.Level2.1_Services.D5Level2_1IOPa | a. Although patient has been an active participant at a less intensive level of care, he/she is experiencing an intensification of symptoms of substance-related disorder and level of functioning is deteriorating, despite modification of the treatment plan; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level2.1_Services.D5Level2_1IOPb | b. High likelihood that patient will continue to use or relapse to use without close outpatient monitoring and structured therapeutic services, as indicated by lack of awareness of relapse triggers, difficulty in coping, or in postponing immediate gratification or ambivalence toward treatment. Patient has unsuccessfully attempted treatment at less intensive level of care, or such treatment is insufficient to stabilize patients condition so that direct admission to Level 2.1 is indicated. OR | 0..1 | boolean | |
| Level2.1_Enhanced | LEVEL 2.1 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level2.1_Enhanced.D5Level2_1DDEa | a. Psychiatric symptoms pose moderate risk of relapse to alcohol, other drug, or other addictive or psychiatric disorder. Such patient has impaired recognition or understanding of relapse issues, and requires Level 2.1 co-occurring enhanced program services to maintain an adequate level of functioning. | 0..1 | boolean | |
| Level2.5_Services | LEVEL 2.5 - Partial Hospitalization Services | 0..1 | group | |
| LOCI3Dimension5.Level2.5_Services.D5Level2_5PHa | a. Although patient has been an active participant at a less intensive level of care, he/she is experiencing an intensification of symptoms of substance-related disorder and level of functioning is deteriorating, despite modification of the treatment plan; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level2.5_Services.D5Level2_5PHb | b. High likelihood that patient will continue to use or relapse to use without close outpatient monitoring and structured therapeutic services, as indicated by lack of awareness of relapse triggers, difficulty in coping, or in postponing immediate gratification or ambivalence toward treatment. Patient has unsuccessfully attempted treatment at less intensive level of care, or such treatment is insufficient to stabilize patients condition so that direct admission to Level 2.5 is indicated. OR | 0..1 | boolean | |
| Level2.5_Enhanced | LEVEL 2.5 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level2.5_Enhanced.D5Level2_5DDEa | a. Psychiatric symptoms pose high risk of relapse to the substance or psychiatric disorder. Such patient has impaired recognition or understanding of relapse issues, and inadequate skills in coping with and interrupting mental disorders and/or avoiding or limiting relapse. Patients follow through in treatment is so inadequate or inconsistent, and relapse problems are escalating to such a degree, that treatment at Level 2.1 is not succeeding or feasible. | 0..1 | boolean | |
| Level3.1_Services | LEVEL 3.1 - Clinically Managed Lowintensity Residential Services | 0..1 | group | |
| LOCI3Dimension5.Level3.1_Services.D5Level3_1HHa | a. Limited coping skills to address relapse triggers and urges and/or deteriorating mental functioning. Thus, in imminent danger of relapse, with dangerous emotional, behavioral, or cognitive consequences; needs 24-hour structure to help apply recovery and coping skills; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.1_Services.D5Level3_1HHb | b. Understands addiction and/or mental disorder but at risk of relapse in a less structured level of care because unable to consistently address either or both; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.1_Services.D5Level3_1HHc | c. Needs staff support to maintain engagement in recovery program while transitioning to life in community; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.1_Services.D5Level3_1HHd | d. At high risk of substance use, addictive behavior, or deteriorated mental functioning, with dangerous emotional, behavioral, or cognitive consequences, in absence of close 24-hour structured support, and issues are being addressed concurrently in a Level 2 program. | 0..1 | boolean | |
| Level3.1_Enhanced | LEVEL 3.1 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level3.1_Enhanced.D5Level3_1DDEa | a. Psychiatric symptoms pose moderate risk of relapse to substance use or mental disorder. AND | 0..1 | boolean | |
| LOCI3Dimension5.Level3.1_Enhanced.D5Level3_1DDEb | b. Has limited ability to apply relapse prevention skills,and deteriorating psychiatric functioning, which increases risk of serious consequences and requires types of services and 24-hour structure of Level 3.1 cooccurring enhanced program in order to maintain adequate level of functioning. Patient receiving concurrent Level 2 and Level 3.1 services requires case management and collaboration to coordinate services across levels of care. AND | 0..1 | boolean | |
| LOCI3Dimension5.Level3.1_Enhanced.D5Level3_1DDEc | c. May include need to manage anticraving, psychotropic,or opioid agonist medications. | 0..1 | boolean | |
| Level3.3_Services | LEVEL 3.3 - Clinically Managed Population Specific HighIntensity Residential Services | 0..1 | group | |
| LOCI3Dimension5.Level3.3_Services.D5Level3_3LTRa | a. Does not recognize relapse triggers and has little awareness of the need for continuing care. Due to intensity or chronicity of patients addictive disorder, or chronicity of mental health problem or cognitive limitations, patient in imminent danger of continued substance use or mental health problems, with dangerous emotional, behavioral, or cognitive consequences. Patient thus needs 24-hour monitoring and structure to assist in application of recovery and coping skills, as well as active staff interventions to prevent relapse; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.3_Services.D5Level3_3LTRb | b. Experiencing an intensification of symptoms of substance use or mental disorder, and level of functioning deteriorating despite an amendment of the treatment plan; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.3_Services.D5Level3_3LTRc | c. Cognitive impairment has limited ability to identify and cope with relapse triggers and high-risk situations. Requires relapse prevention activities delivered at a slower pace, more concretely, and more repetitively, in a setting that provides 24-hour structure and support to prevent imminent dangerous consequences; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.3_Services.D5Level3_3LTRd | d. Despite recent, active participation in treatment at less intensive level of care, patient continues to use, continue other addictive behavior or to deteriorate psychiatrically, with imminent serious consequences. High risk of continued substance use, addictive behavior, or mental deterioration without close 24-hour monitoring and structured treatment. | 0..1 | boolean | |
| Level3.3_Enhanced | LEVEL 3.3 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level3.3_Enhanced.D5Level3_3DDEa | a. Psychiatric symptoms pose moderate risk of relapse to substance use or mental disorder. AND | 0..1 | boolean | |
| LOCI3Dimension5.Level3.3_Enhanced.D5Level3_3DDEb | b. Has limited ability to apply relapse prevention skills,and poor skills in coping with mental disorders and/or avoiding or limiting relapse, with imminent serious consequences. AND | 0..1 | boolean | |
| LOCI3Dimension5.Level3.3_Enhanced.D5Level3_3DDEc | c. Case management and collaboration across levels of care may be needed to manage anti-craving,psychotropic, or opioid agonist medications. | 0..1 | boolean | |
| Level3.5_Services | LEVEL 3.5 - Clinically Managed HighIntensity Residential Services | 0..1 | group | |
| LOCI3Dimension5.Level3.5_Services.D5Level3_5LTRa | a. Does not recognize relapse triggers, lacks insight into benefits of continuing care, and is therefore not committed to treatment. Continued substance use poses imminent danger of harm to self or others in absence of 24-hour monitoring and structured support; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Services.D5Level3_5LTRb | b. Psychiatric condition is stabilizing. However, despite best efforts, patient unable to control use of alcohol,other drugs, and/or antisocial behaviors, with attendant probability of harm to self or others. Limited ability to interrupt relapse process or continued use, or to use peer supports when at risk for relapse to addiction or mental disorder. Continued substance use poses an imminent danger of harm to self or others in absence of 24-hour monitoring and structured support; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Services.D5Level3_5LTRc | c. Experiencing psychiatric or addiction symptoms such as drug craving, insufficient ability to postpone immediate gratification, and other drug-seeking behaviors. Situation poses imminent danger of harm to self or others in absence of close 24-hour monitoring and structured support. Introduction of psychopharmacologic support indicated to decrease psychiatric or addictive symptoms, such as cravings, that enable the patient to delay immediate gratification and reinforce positive recovery behaviors; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Services.D5Level3_5LTRd | d. In imminent danger of relapse or continued use, with dangerous emotional, behavioral, or cognitive consequences, as a result of a crisis situation; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Services.D5Level3_5LTRe | e. Despite recent, active participation in treatment at a less intensive level of care, patient continues to use, or to deteriorate psychiatrically, with imminent serious consequences, and is at high risk of continued substance use or mental deterioration in absence of close 24-hour monitoring and structured treatment; | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Services.D5Level3_5LTRf | f. Patient demonstrates a lifetime history of repeated incarceration with a pattern of relapse to substances and uninterrupted use outside of incarceration, with imminent risk of relapse to addiction or mental health problems and recidivism to criminal behavior. Poses imminent risk of harm to self or others. Patients imminent danger of relapse accompanied by an uninterrupted cycle of relapse-reoffendingincarceration-release-relapse without the opportunity for treatment. Requires 24-hour monitoring and structure to assist in initiation and application of recovery and coping skills. | 0..1 | boolean | |
| Level3.5_Enhanced | LEVEL 3.5 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level3.5_Enhanced.D5Level3_5DDEa | a. Psychiatric symptoms pose moderate risk of relapse to substance use or mental disorder. AND | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Enhanced.D5Level3_5DDEb | b. Demonstrates limited ability to apply relapse prevention skills, as well as inadequate skills in coping with mental disorders and/or avoiding or limiting relapse, with imminent serious consequences. AND | 0..1 | boolean | |
| LOCI3Dimension5.Level3.5_Enhanced.D5Level3_5DDEc | c. Case management and collaboration across levels of care may be needed to manage anti-craving,psychotropic, or opioid agonist medications. | 0..1 | boolean | |
| Level3.7_Services | LEVEL 3.7 - Medically Monitored Intensive Inpatient Services | 0..1 | group | |
| LOCI3Dimension5.Level3.7_Services.D5Level3_7STRa | a. Experiencing acute psychiatric or substance use crisis,marked by intensification of symptoms of addictive or mental disorder. Situation poses serious risk of harm to self or others in absence of 24-hour monitoring and structured support; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.7_Services.D5Level3_7STRb | b. Experiencing an escalation of relapse behaviors and/or reemergence of acute symptoms, which places patient at serious risk to self or others in absence of the type of 24-hour monitoring and structured support found in a medically monitored setting; OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.7_Services.D5Level3_7STRc | c. Modality or intensity of treatment protocols to address relapse require that patient receive care in a Level 3.7 program to safely and effectively initiate antagonist therapy or agonist therapy. | 0..1 | boolean | |
| Level3.7_Enhanced | LEVEL 3.7 - Co-occurring Enhanced | 0..1 | group | |
| LOCI3Dimension5.Level3.7_Enhanced.D5Level3_7DDEa | a. Psychiatric symptoms pose moderate to high risk of relapse to a substance use or mental disorder. OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.7_Enhanced.D5Level3_7DDEb | b. Demonstrates limited ability to apply relapse prevention skills, as well as demonstrating poor skills in coping with psychiatric disorders and/or avoiding or limiting relapse, with imminent serious consequences. OR | 0..1 | boolean | |
| LOCI3Dimension5.Level3.7_Enhanced.D5Level3_7DDEc | c. Follow through in treatment is limited or inconsistent,and relapse problems are escalating to such a degree that treatment at a less intensive level of care is not succeeding or feasible. | 0..1 | boolean | |
| Documentation for this format | ||||