registry info form · 2016. 12. 20. · 1000000255 = inpatient - adult - short term (

LADDS Data Dictionary (Crosswalk)

LADDS Data Dictionary-Crosswalk - February 2010 Page 1 of 26

Data Element Description Data Type Value Label TEDS DATA Coding/RemarkscliUniqueID Unique ID nvarchar (12) System auto-generated after User Input NOT TEDS

(Birth Date + Gender + First & Last Letter First Name + First & Last Letter Last Name + Random Number)

cliCode is the TEDS Client Identifier (MDS 2) TEDS - MDS 2

MMDDYY + G + FF + LF + FL + LL + X cliCode is the TEDS Client Identifier (DIS 5) TEDS - DIS 5cliCode is the TEDS Client Identifier (DIS 12) TEDS - DIS 12

cliLastName Last Name nvarchar (30) User input NOT TEDSclilFirstName First Name nvarchar (30) User input NOT TEDScliMiddle Middle Name / Initial nvarchar (30) User input NOT TEDScliBirthName Birth Name nvarchar (50) User input NOT TEDScliSuffix Suffix (Jr., Sr., III, etc...) nvarchar (10) User input NOT TEDScliSSN SSN nvarchar (9) User input NOT TEDScliHomePhone Home Phone nvarchar (20) User input NOT TEDScliWorkPhone Work Phone nvarchar (20) User input NOT TEDScliAddress Address nvarchar (40) User input NOT TEDScliAptNo Apartment Number nvarchar (20) User input NOT TEDScliCity City nvarchar (30) User input NOT TEDScliState State nvarchar (2) User input NOT TEDScliZip Zip nvarchar (10) User input NOT TEDScliParish Parish nvarchar (2) 01 = Acadia NOT TEDS

02 = Allen03 = Ascension04 = Assumption05 = Avoyelles06 = Beauregard07 = Bienville08 = Bossier09 = Caddo10 = Calcasieu11 = Caldwell12 = Cameron13 = Catahoula14 = Claiborne15 = Concordia16 = DeSoto17 = East Baton Rouge18 = East Carroll19 = East Feliciana20 = Evangeline21 = Franklin22 = Grant23 = Iberia24 = Iberville25 = Jackson26 = Jefferson27 = Jefferson Davis28 = Lafayette29 = Lafourche

REGISTRY INFO FORM



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks30 = LaSalle31 = Lincoln32 = Livingston33 = Madison34 = Morehouse35 = Natchitoches36 = Orleans37 = Ouachita38 = Plaquemines39 = Pointe Coupee40 = Rapides41 = Red River42 = Richland43 = Sabine44 = St. Bernard45 = St. Charles46 = St. Helena47 = St. James48 = St. John the Baptist49 = St. Landry50 = St. Martin51 = St. Mary52 = St. Tammany53 = Tangipahoa54 = Tensas55 = Terrebonne56 = Union57 = Vermilion58 = Vernon59 = Washington60 = Webster61 = West Baton Rouge62 = West Carroll63 = West Feliciana64 = Winn99 = Out Of State

cliBirthDate Birth Date smalldatetime User input (MM/DD/YYYY) TEDS - Date of Birth (MDS 8) TEDS - MDS 8

TEDS - Date of Birth (DIS 17) TEDS - DIS 17

cliSex Gender nvarchar (1) TEDS - Sex (MDS 9 & DIS 18 ) TEDS - MDS 9F = Female 2 = Female TEDS - DIS 18M = Male 1 = Male

cliRace Race nvarchar (10) TEDS - Race (MDS 10 & DIS 19 ) TEDS - MDS 101000000552 = Alaskan Native 01 = Alaska Native TEDS - DIS 191000000213 = American Indian 02 = American Indian1000000214 = Asian 13 = Asian1000000215 = Black or African American 04 = Black or African American1000000216 = Native Hawaiian / Other Pacific Islander 23 = Native Hawaiian/Other Pac. Is.



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000217 = White 05 = White1000000438 = Other 20 = Other Single Race

cliEthnicity Ethnicity nvarchar (10) TEDS - Ethnicity (MDS 11 & DIS 20 ) TEDS - MDS 111000000441 = Hispanic or Latino 06 = Hispanic TEDS - DIS 201000000211 = Not Hispanic 05 = Not Hispanic

cliFirstLanguage First Language nvarchar (10) 1000000370 = English NOT TEDS1000000371 = Spanish1000000442 = French1000000443 = Vietnamese1000000444 = Chinese1000000445 = Hindi or related language1000000446 = Arabic1000000517 = Other1000000518 = German1000000519 = Russian

cliDisability Disability nvarchar (20) A = None NOT TEDSB = Sight ImpairedC = Hearing ImpairedD = Not Ambulatory without wheelchair or walkerE = One or more limbs amputatedF = Asthma, emphysema or other breathing difficultyG = TuberculosisH = HIV DiseaseI = Hepatitis CJ = Other Serious or Chronic Medical Condition

cliContactDate Date of Initial Contact smalldatetime User input NOT TEDS

cliAppointmentDate Appointment Date smalldatetime User input NOT TEDS

cliHurricaneAdmit Hurricane Info Case Number nvarchar (10) System auto-generated after User Input @ Initial Interview NOT TEDS

waiStatus Waiting List Status nvarchar (10) P = Pending NOT TEDSW = WaitingD = DeniedA = AcceptedE = Referred ElsewhereR = Removed

waiRemoveReason Waiting List Inpatient Remove Reason nvarchar (10) 1000000621 = Client failed to present for Admssion NOT TEDS1000000622 = No contact with Referral Source for 30 days

Waiting List Inpatient Deny Reason nvarchar (10) 1000000617 = Medically unstable NOT TEDS1000000618 = Psychiatrically unstable1000000619 = Does not meet admission criteria1000000620 = Not enough information

Waiting List Outpatient Remove Reason nvarchar (10) 1000000593 = Client Deceased NOT TEDS1000000594 = Client Incarcerated1000000613 = Client Refused/Declined Recommended LOC1000000614 = LOC No longer indicated or needed

WAITING LIST



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000615 = Last Contact w/client / Client moved1000000616 = Other

admClient Client nvarchar (10) Auto-Generated Number NOT TEDSadmStatus Status nvarchar (10) System Auto-Generated NOT TEDS

1000000361 = Closed Case (Terminated Case)1000000362 = Expired Contact (Not admitted contact case after 30 days)1000000363 = Expired Case (Admitted case with no service for 90 days)1000000364 = Active Case (Open Case)1000000365 = Contact Case (Contact Case/not admitted)1000000366 = Affiliate Case (Open Case)

admInterviewer Interviewer nvarchar (6) Note: Table lookup too long and constantly change. TEDS - Provider Identifier (MDS 1 & DIS 11 ) TEDS - MDS 1TEDS - DIS 11

TEDS - Provider Identifier at Discharge (DIS 11 ) TEDS - DIS 4admInterviewDate Interviewer Date smalldatetime User input NOT TEDS

admPregnant Pregnant at Initial Interview nvarchar (1) TEDS - Pregnant at time of Admission (SUDS 6) TEDS - SUDS 6N = No 2 = NoY = Yes 1 = YesX = N/A (Auto-generated for Male client) 6 = Not Applicable (For Male)

admArrests30Days Arrests in 30 Days Prior to Admission nvarchar (2) User input TEDS - Arrest in 30 Days Prior to Admission (SUDS 16)

TEDS - SUDS 16

admFreqAttn Self Help Activities 30 Days Prior to Admission

nvarchar (10) TEDS - Frequency of Attendance at Self-Help Programs in 30 Days Prior to Admission (SUDS 17)

TEDS - SUDS 17

1000000627 = No attendance in the past month 01 = No attendance in past month1000000629 = 1-3 times in past month 02 = 1-3 times in past month1000000630 = 4-7 times in past month 03 = 4-7 times in past month1000000631 = 8-15 times in past month 04 = 8-15 times in past month1000000632 = 16-30 times in past month 05 = 16-30 times in past month1000000633 = Some attendance, but frequency unknown 06 = Some attendance, but frequency unknown

admReferralSource Source of Referral nvarchar (10) TEDS - Principal Referral Source (MDS 7) TEDS - MDS 71000000196 = Self, Family or Friend 01 = Individual (Includes Self-Referral)1000000197 = Coroner or Physician 02 = Alcohol/Drug Abuse Care Provider1000000198 = Mental Health Facility 03 = Other Health Care Provider1000000199 = Court/Crim Justice City Parish 04 = School (Educational)1000000200 = Court/Crim Justice State 05 = Employer1000000201 = Child/Adult Protection Program 06 = Other Community Referral1000000202 = Other Chemical Dependency Program - Private 07 = Court/Criminal Justice Referral1000000204 = Employee Assistance Program DUI/DWI1000000205 = Bureau Of Prisons / Federal Probation & Parole1000000206 = Educational Program TEDS - Detailed Criminal Justice Referral TEDS - SUDS 131000000207 = Drug Court 01 = State / Federal Court1000000208 = FITAP 02 = Other Court (Not State or Federal)1000000412 = Other 03 = Probation / Paroled1000000457 = Other Chemical Dependency Program - Public 04 = Other Recognized Legal Entity1000000458 = TANF 05 = Diversionary Program1000000501 = TANF-EE (Not Active) 06 = Prison

INITIAL INTERVIEW FORM



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000543 = MPWP 07 = DUI / DWI1000000551 = Gambling TX Referral Program 08 = Other1000000596 = Pregnant & Postpartum Women Grant (PPW) 96 = Not Applicable1000000608 = TANF-Residential Women and Dependent Children Program 97 = Unknown1000000585 = OCS/TANF Gender Specific IOP1000000586 = OCS/Non-TANF1000000610 = OCS/TANF

admContactReason Reason for Contact nvarchar (10) 1000000191 = Evaluation Only TEDS - MDS 31000000192 = Non-Crisis, Counsel - Self TEDS - DIS 131000000193 = Non-Crisis, Counsel - Collateral 1 = Yes1000000194 = Crisis Intervention - Self 2 = No1000000195 = Crisis Intervention - Collateral1000000544 = Screening Only

admAddictionType Addiction Type nvarchar (10) 1000000187 = Alcohol NOT TEDS1000000188 = Drugs1000000189 = Alcohol & Drugs1000000190 = Gambling1000000406 = Tobacco (Not Active)1000000407 = None (For Children Only)1000000408 = Other

admUsedDrugs Used IV Drugs nvarchar (10) 1000000377 = Used IV Drugs in last 6 months NOT TEDS1000000378 = Used IV Drugs in last year1000000433 = Last Used IV Drugs More Than 1 Year Ago1000000434 = Never Used IV Drugs

cliSexualPreference Sexual Preference nvarchar (10) 1000000372 = Males Only NOT TEDS1000000373 = Females Only1000000374 = Both Males and Females1000000405 = No Answer

admImpacted Were you IMPACTED by the nvarchar (1) N = No NOT TEDShurricane / disaster Y = Yes

admImpactedDisaster If Yes, select which disaster nvarchar (1) A = Katrina NOT TEDSB = RitaC = GustavD = IkeX = Other _______________________

admImpactedHow How were you impacted by the nvarchar (1) M = Moderate NOT TEDShurricane / disaster? S = Severe

admDisplaced Were you DISPLACED by the nvarchar (1) N = No NOT TEDShurricane / disaster? Y = Yes

admDisplacedDisaster Select which disaster nvarchar (1) A = Katrina NOT TEDSB = RitaC = GustavD = IkeX = Other _______________________

admDisplacedServices Before the hurricane / disaster, were nvarchar (1) N = No NOT TEDSyou receiving services at an OAD funded program / facility?

Y = Yes

TEDS - Co-Dependent/Collateral (MDS 3 & DIS 13 )



Data Element Description Data Type Value Label TEDS DATA Coding/RemarksadmDisplacedZipcode What was the client's Zip Code of

residence prior to the disaster?User input NOT TEDS

admDisplacedParish What was the client's Parish of residence prior to the disaster?

System auto-generated after User Input of the Zip Code (admdisplacedZipcode) NOT TEDS

admAdmitType Type of admission nvarchar (1) (Auto-generated) NOT TEDSF = FirstR = Readmission

admAffiliate Affiliate nvarchar (1) (Auto-generated) NOT TEDSY = YesN = No

admCaseNumber Case Number nvarchar (9) (Auto-generated) NOT TEDSadmDiagnositic Diagnostic Impression nvarchar (10) User input (XXX.XX) TEDS - DSM Diagnosis (SUDS 4) TEDS - SUDS 4

admServiceType Service Type nvarchar (10) TEDS - Type of Services (MDS 18) & DIS 16 TEDS - MDS 181000000253 = Intensive Outpatient 01 = Detoxification, 24-Hour Service , TEDS - DIS 161000000254 = Non-Intensive Outpatient Hospital Inpatient1000000255 = Inpatient - Adult - Short Term (30 days) Free-Standing Residential1000000257 = Medical Detoxification / Hospital Setting (24-hour) 03 = Rehabilitation/Residential - Hospital1000000258 = Social Detoxification Other than Detoxification1000000259 = Halfway / 3-Qtr House (Adult or Adolescent) 04 = Rehabilitation/Residential1000000261 = Therapeutic Community - Structured - long Term Short Term (30 Days or Fewer)1000000262 = Recovery Home 05 = Rehabilitation/Residential 1000000513 = Medically Supported Detoxification / Non-Hospital Long Term (More than 30 Days)1000000514 = Inpatient - Adolescent - Long Term >(30 days) 06 = Ambulatory - Intensive-Outpatient

07 = Ambulatory - Non-Intensive Outpatient08 = Ambulatory - Detoxification

admLegalStatus Legal Status nvarchar (10) 1000000170 = Voluntary NOT TEDS1000000171 = Non-Contested1000000172 = Emergency Certificate1000000173 = Judicial Commitment1000000174 = Court Order / DWI (1st & 2nd)1000000175 = Court Order / Non DWI / Drug Court1000000545 = Court Order DWI 3rd Offense Conviction1000000546 = DWI 3rd Pending1000000547 = Court Order DWI 4th Offense Conviction1000000548 = DWI 4th Pending

admDWICoordinator DWI Coordinator nvarchar (10) Select assigned Regional DWI Coordinator NOT TEDSadmProbationOfficer Probation Officer nvarchar (30) User Input NOT TEDSadmPriorMHService Prior MH Service nvarchar (1)

N = NoTEDS - Psychiatric Problem in Addition to Alcohol or

Drug Problems (SUDS 5)TEDS - SUDS 5

Y = Yes 1 = Yes ; 2 = NoadmPriorTXEpisodes Prior SA Treatment nvarchar (10)

1000000402 = 1TEDS - Psychiatric Problem in Addition to Alcohol or

Drug Problems (MDS 6)TEDS - MDS 6

1000000403 = 2 0 = 0 Previous Episode1000000404 = 3 1 = 1 Previous Episode1000000448 = 4 2 = 2 Previous Episodes1000000449 = 5 3 = 3 Previous Episodes1000000450 = 0 4 = 4 Previous Episodes



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000451 = 6 5 = 5 or More Previous Episodes 1000000452 = 7 7 = Unknown1000000453 = 8 8 = Not Collected1000000454 = 9 +1000000455 = Unknown

admveteran Veteran nvarchar (1) N = No TEDS - Veteran Status (SUDS 7) TEDS - SUDS 7Y = Yes 1 = Yes ; 2 = No

Veteran of the Iraq / Afghan War? nvarchar (1) N = No NOT TEDSY = Yes

admeducation nvarchar (10) 1000000484 = 1st Grade1000000485 = 2nd Grade1000000486 = 3rd Grade

This data element 1000000487 = 4th Grade This data elementhas been deleted and 1000000488 = 5th Grade has been disabled andreplaced with 1000000489 = 6th Grade replaced withadmEducationYears 1000000490 = 7th Grade admEducationYears

1000000491 = 8th Grade1000000492 = 9th Grade1000000493 = 10th Grade1000000494 = 11th Grade1000000495 = 12th Grade1000000502 = 13 years1000000503 = 14 years1000000504 = 15 years1000000505 = 16 years (BA of BS degree)1000000506 = 17 years1000000507 = 18 years (MA or MS or other Masters)1000000508 = 19 years1000000509 = 20 years1000000510 = Never attended school1000000511 = 21 years 1000000512 = Ungraded ed. prog. or cannot classify 1000000534 = 22 years1000000535 = 23 years1000000536 = 24 years1000000537 = 25 years or more

admEducationYears nvarchar (2) User Input (2-digits) TEDS - Education (MDS 12) TEDS - MDS 12Valid entries should be 00 to 25 00 = Less Than One Grade Completed97 = Unknown 01 - 25 = Years of School Completed

97 = Unknownadmmarital Marital Status nvarchar (10) 1000000164 = Never Married TEDS - Marital Status (SUDS 14) TEDS - SUDS 14

1000000165 = Married 01 = Never Married1000000166 = Remarried 02 = Now Married1000000167 = Separated 03 = Separated1000000168 = Divorced 04 = Divorced1000000169 = Widowed 05 = Widowed

admhousehold Household Composition nvarchar (10) 1000000156 = Adult Only NOT TEDS1000000157 = Adult - Relative

Years of Educational Attainment

Years of Educational Attainment



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000158 = Adult - Non-Relative1000000159 = Child - Both Parents1000000160 = Child - One Parent1000000161 = Child - Relatives / Not Parents1000000162 = Child - Foster Family1000000163 = Child - Non-Relative

admresidence Type of Residence nvarchar (10) TEDS - Living Arrangements (SUDS 8) TEDS - SUDS 81000000153 = Independent 01 = Homeless1000000154 = Dependent 02 = Dependent Living1000000155 = Homeless 03 = Independent Living1000000605 = Shelter 01 = Homeless

admchilddependent Dependent Children Integer User input NOT TEDSadmedhistory History of Emotional Disorder nvarchar (1) N = No NOT TEDS Deleted Data

(deleted data elements) Y = Yes Elementsadmedcurrent Co-Occurring Status nvarchar (10) 1000000376 = No history NOT TEDS

1000000375 = Yes - has historyadmmethadone nvarchar (1) N = No TEDS - Opioid Replacement Therapy (MDS 19) TEDS - MDS 19

Y = Yes 1 = Yes ; 2 = Noadmactivities Self-Help Activities (Social Support of

Recovery) nvarchar (10) 1000000430 = Actively Involved in Self-HelpNOT TEDS Not Active Since January

20101000000431 = Some Self-Help1000000432 = Rejects Self-Help1000000582 = Not ApplicableUnknown

admContEnviron Controlled Environment nvarchar (1) N = No NOT TEDSY = Yes

admWhatContEnviron What Controlled Environment? nvarchar (10) 1000000602 = Close Supervised Jail/Detention Center NOT TEDS1000000603 = 24hr Supervised Inpatient/Residential Program1000000604 = Locked Hospital Units

admdrug1 Abuse/Addiction Type (Primary) nvarchar (10) 1000000105 = None TEDS - Substance Problem Code, Primary TEDS - MDS 14(A)1000000106 = Heroin 01 = None1000000107 = Non-Rx Methadone 02 = Alcohol1000000108 = Other Opiates and Synthetics 03 = Cocaine / Crack1000000109 = Alcohol 04 = Marijuana / Hashish1000000110 = Barbiturates 05 = Heroin1000000111 = Other Sedatives or Hypnotics 06 = Non-Prescription Methadone1000000112 = Amphetamines 07 = Other Opiates and Synthetics1000000113 = Cocaine 08 = PCP1000000114 = Marijuana / Hashish 09 = Other Hallucinogens1000000115 = Hallucinogens 10 = Methamphetamine1000000116 = Inhalants 11 = Other Methamphetamines1000000117 = Over-the-Counter 12 = Other Stimulants1000000118 = Tranquilizers 13 = Benzodiazepines1000000119 = Tobacco 14 = Other Non-Benzodiazepine Tranquilizer1000000120 = PCP 15 = Barbiturates1000000121 = Other Stimulants 16 = Other Non-Barbiturate Sedatives or1000000122 = Benzodiazepines Hypnotics1000000123 = Methamphetamines 17 = Inhalants

Use of Methadone as Part of TX Plan



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000578 = Oxycontin 18 = Over-the-Counter1000000579 = Ecstasy 20 = Other1000000580 = GHB 97 = Unknown1000000124 = Gambling1000000606 = SOMA1000000125 = Other

admdrug1freq Frequency of Use (Primary) nvarchar (10) TEDS - Frequency of Use, Primary TEDS - MDS 16(A)

1000000099 = No Use During Past Month 01 = No Use During Past Month

1000000100 = One to Three Times in Past Month 02 = One to Three Times in Past Month1000000101 = One to Two Times Per Week 03 = One to Two Times Per Week1000000102 = Three to Six Times per Week 04 = Three to Six Times per Week1000000103 = Daily 05 = Daily1000000582 = Not Applicable 96 = Not Applicable

admdrug1method nvarchar (10) TEDS - Route of Administration, Primary TEDS - MDS 15(A)

1000000292 = Oral 01 = Oral1000000293 = Injection 04 = Injection1000000294 = Smoking 02 = Smoking1000000295 = Inhalation 03 = Inhalation1000000296 = Other 20 = Other1000000582 = Not Applicable 96 = Not Applicable1000000297 = None Reported 97 = Unknown

admdrug1age Age of first abuse (Primary) nvarchar (2) TEDS - Age of First Use, Primary TEDS - MDS 17(A)

00 = Newborn with substance dependency1 - 95 = valid Age of First Use entry 01 - 95 = Indicates the Age of First Use96 = No drug abuse present 96 = Not ApplicableNote: This field is cross-checked with clibirthdate, "Birth Date" 97 = Unknown

admdrug2 nvarchar (10) 1000000105 = None TEDS - Substance Problem Code, Secondary TEDS - MDS 14(B)1000000106 = Heroin 01 = None1000000107 = Non-Rx Methadone 02 = Alcohol1000000108 = Other Opiates and Synthetics 03 = Cocaine / Crack1000000109 = Alcohol 04 = Marijuana / Hashish1000000110 = Barbiturates 05 = Heroin1000000111 = Other Sedatives or Hypnotics 06 = Non-Prescription Methadone1000000112 = Amphetamines 07 = Other Opiates and Synthetics1000000113 = Cocaine 08 = PCP1000000114 = Marijuana / Hashish 09 = Other Hallucinogens1000000115 = Hallucinogens 10 = Methamphetamine1000000116 = Inhalants 11 = Other Methamphetamines1000000117 = Over-the-Counter 12 = Other Stimulants1000000118 = Tranquilizers 13 = Benzodiazepines1000000119 = Tobacco 14 = Other Non-Benzodiazepine Tranquilizer1000000120 = PCP 15 = Barbiturates1000000121 = Other Stimulants 16 = Other Non-Barbiturate Sedatives or1000000122 = Benzodiazepines Hypnotics1000000123 = Methamphetamines 17 = Inhalants1000000578 = Oxycontin 18 = Over-the-Counter

Route of Administration (Primary)

Abuse/Addiction Type (Secondary)



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000579 = Ecstasy 20 = Other1000000580 = GHB 97 = Unknown1000000124 = Gambling1000000606 = SOMA1000000125 = Other

admdrug2freq nvarchar (10) TEDS -Frequency of Use, Secondary TEDS - MDS 16(B)1000000099 = No Use During Past Month 01 = No Use During Past Month1000000100 = One to Three Times in Past Month 02 = One to Three Times in Past Month1000000101 = One to Two Times Per Week 03 = One to Two Times Per Week1000000102 = Three to Six Times per Week 04 = Three to Six Times per Week1000000103 = Daily 05 = Daily1000000582 = Not Applicable 96 = Not Applicable

admdrug2method nvarchar (10) TEDS - Route of Administration, Secondary TEDS - MDS 15(B)1000000292 = Oral 01 = Oral1000000293 = Injection 04 = Injection1000000294 = Smoking 02 = Smoking1000000295 = Inhalation 03 = Inhalation1000000296 = Other 20 = Other1000000582 = Not Applicable 96 = Not Applicable1000000297 = None Reported 97 = Unknown

admdrug2age Age of first abuse (Secondary) nvarchar (2) TEDS - Age of First Use, Secondary TEDS - MDS 17(B)00 = Newborn with substance dependency

1 - 95 = valid Age of First Use entry 01 - 95 = Indicates the Age of First Use96 = No drug abuse present 96 = Not ApplicableNote: This field is cross-checked with clibirthdate, "Birth Date" 97 = Unknown

admdrug3 nvarchar (10) 1000000105 = None TEDS - Substance Problem Code, Tertiary TEDS - MDS 14(C)1000000106 = Heroin 01 = None1000000107 = Non-Rx Methadone 02 = Alcohol1000000108 = Other Opiates and Synthetics 03 = Cocaine / Crack1000000109 = Alcohol 04 = Marijuana / Hashish1000000110 = Barbiturates 05 = Heroin1000000111 = Other Sedatives or Hypnotics 06 = Non-Prescription Methadone1000000112 = Amphetamines 07 = Other Opiates and Synthetics1000000113 = Cocaine 08 = PCP1000000114 = Marijuana / Hashish 09 = Other Hallucinogens1000000115 = Hallucinogens 10 = Methamphetamine1000000116 = Inhalants 11 = Other Methamphetamines1000000117 = Over-the-Counter 12 = Other Stimulants1000000118 = Tranquilizers 13 = Benzodiazepines1000000119 = Tobacco 14 = Other Non-Benzodiazepine Tranquilizer1000000120 = PCP 15 = Barbiturates1000000121 = Other Stimulants 16 = Other Non-Barbiturate Sedatives or1000000122 = Benzodiazepines Hypnotics1000000123 = Methamphetamines 17 = Inhalants1000000578 = Oxycontin 18 = Over-the-Counter1000000579 = Ecstasy 20 = Other1000000580 = GHB 97 = Unknown1000000124 = Gambling

Abuse/Addiction Type (Tertiary)

Frequency of Use (Secondary)

Route of Administration (Secondary)



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000606 = SOMA1000000125 = Other

admdrug3freq Frequency of Use (Tertiary) nvarchar (10) TEDS - Frequency of Use, Tertiary TEDS - MDS 16(C)1000000099 = No Use During Past Month 01 = No Use During Past Month1000000100 = One to Three Times in Past Month 02 = One to Three Times in Past Month1000000101 = One to Two Times Per Week 03 = One to Two Times Per Week1000000102 = Three to Six Times per Week 04 = Three to Six Times per Week1000000103 = Daily 05 = Daily1000000582 = Not Applicable 96 = Not Applicable

admdrug3method nvarchar (10) TEDS - Route of Administration, Tertiary TEDS - MDS 15(C)1000000292 = Oral 01 = Oral1000000293 = Injection 04 = Injection1000000294 = Smoking 02 = Smoking1000000295 = Inhalation 03 = Inhalation1000000296 = Other 20 = Other1000000582 = Not Applicable 96 = Not Applicable1000000297 = None Reported 97 = Unknown

admdrug3age Age of first abuse (Tertiary) nvarchar (2) TEDS - Age of First Use, Tertiary TEDS - MDS 17(C)00 = Newborn with substance dependency

1 - 95 = valid Age of First Use entry 01 - 95 = Indicates the Age of First Use96 = No drug abuse present 96 = Not ApplicableNote: This field is cross-checked with clibirthdate, "Birth Date" 97 = Unknown

admq1 nvarchar (1) N = No NOT TEDSY = Yes

admq2 nvarchar (1) N = No NOT TEDSY = Yes

admdisposition Disposition nvarchar (10) 1000000086 = Admission TEDS - Client Transaction Type (MDS 4) TEDS - MDS 41000000087 = Referred Elsewhere & DIS 14 TEDS - DIS 141000000088 = No Further Service Requested1000000089 = No further Service Required A = Admission1000000090 = Education Program T = Transfer1000000091 = Deferred Admission1000000092 = Initial Assessment Only

admcontactdate Date of Initial Contact smalldatetime User input NOT TEDS

How was Contact Made nvarchar (10) 1000000597 = Face to Face1000000598 = Phone1000000600 = Sibling1000000601 - Other

admadmitdate Admission Date smalldatetime User input TEDS - Date of Admission (MDS 5) TEDS - MDS 5

& DIS 15 TEDS - DIS 15adminterviewer Assigned Counselor nvarchar (6) Note: Table lookup too long and constantly change. TEDS - Provider Identifier (MDS 1) TEDS - MDS 1

admclient Client nvarchar (10) Auto-Generated from Registry Info NOT TEDSadmcasenumber Case Number nvarchar (9) Auto-Generated from Initial Interview NOT TEDS

FINANCIAL INFO FORM

Route of Administration (Tertiary)

Have you ever felt the need to bet more and more moneyHave you ever had to lie to people important to you about how much you



Data Element Description Data Type Value Label TEDS DATA Coding/Remarksadmdisposition Disposition nvarchar (10) Auto-Generated from Initial Interview NOT TEDSadmlegalstatus Legal Status nvarchar (10) Auto-Generated from Initial Interview NOT TEDSadmreferralsource Referral Source nvarchar (10) Auto-Generated from Initial Interview NOT TEDSadmemployment Employment Status nvarchar (10) TEDS - Employment Status (MDS 13) TEDS - MDS 13

1000000143 = Employed Full Time 01 = Full Time1000000144 = Employed Part Time 02 = Part Time1000000145 = Occasional / Seasonal Worker 03 = Unemployed1000000146 = Unemployed 04 = Not in Labor Force1000000147 = Homemaker 97 = Unknown1000000148 = Student1000000149 = Retired TEDS - Detailed Not In Labor Force (SUDS 12) TEDS - SUDS 121000000150 = Institutional Inmate 01 = Homemaker1000000151 = Disabled 02 = Student1000000152 = Other 03 = Retired

04 = Disabled05 = Inmate of Institution (Prison)06 = Other96 = Not Applicable97 = Unknown

admincome Source of Household Income nvarchar (15) A = None TEDS - Source of Income/Support (SUDS 9) TEDS - SUDS 9

B = Wages/Salary 01 = Wages / SalaryC = Non-Farm Self Employment 02 = Public AssistanceD = Farm Self Employment 03 = Retirement / PensionE = Interest, Dividends, Royals or Net Rentals 04 = DisabilityF = Social Security/Railroad Insurance 20 = OtherG = SSI, FITAP, Other Public Assistance 21 = NoneH = Other 97 = Unknown

admmonthlyincome Integer User input NOT TEDS

admincomedependents Dependents on Above Income Integer User input NOT TEDSadmfee Amount of Fee Integer User input NOT TEDSadmhealthinsurance Health Insurance nvarchar (15) TEDS - Health Insurance (SUDS 10) TEDS - SUDS 10

1000000553 = Blue Cross / Blue Shield 01 = Private Insurance1000000554 = Medicare 02 = Blue Cross / Blue Shield1000000555 = Medicaid 03 = Medicare1000000556 = Health Maintenance Organization (HMO) 04 = Medicaid1000000557 = CHAMPUS 06 = Health Maintenance Org. (HMO)1000000558 = VA 20 = Other (E.G. Tricare, CHAMPUS)1000000559 = None 21 = None1000000577 = Private Insurance 97 = Unknown

admpaysource Sources of Payment nvarchar (15) A = No Fee Payment TEDS - Primary Source of Payment (SUDS 11) TEDS - SUDS 11B = Personal Resources 01 = Self-PayC = Private Health Insurance 02 = Blue Cross / Blue ShieldD = Medicare 03 = MedicareE = Medicaid 04 = MedicaidF = VA 05 = Other Government PaymentsG = CHAMPUS 06 = Worker's Compensation

Average Gross Monthly Income



Data Element Description Data Type Value Label TEDS DATA Coding/RemarksH = Other Public Sources 07 = Other Health Insurance CompaniesI = DWI (Deleted as of 03/2006) 08 = No Charge (Free, Charity, or Teaching)J = FITAP 09 = OtherK = TANF 97 = UnknownL = UDS (Fiscal Use Only)M = Drug CourtO = MPWP

admmedicare Medicare Number nvarchar (20) User input NOT TEDSadmmedicaid Medicaid Number nvarchar (20) User input NOT TEDSadmeligmonth Medicaid Eligibility Month nvarchar (10) 1000000005 = January NOT TEDS

1000000006 = February1000000007 = March1000000008 = April1000000009 = May1000000010 = June1000000011 = July1000000012 = August1000000013 = September1000000014 = October1000000015 = November1000000016 = December

admeligyear Medicaid Eligibility Year nvarchar (4) User input NOT TEDS

admclient Client nvarchar (10) Auto-Generated from Registry Info NOT TEDSadmcasenumber Case Number nvarchar (9) Auto-Generated from Initial Interview NOT TEDSevaevaldate Evaluation Date smalldatetime User Input NOT TEDS

evadiag1 Diagnosis 1 nvarchar (6) User Input NOT TEDSevadiag2 Diagnosis 2 nvarchar (6) User Input NOT TEDSevadiag3 Diagnosis 3 nvarchar (6) User Input NOT TEDSevaarrest Number of Arrests nvarchar (2) User Input NOT TEDSevaResidence Type of Residence nvarchar (10) 1000000153 = Independent NOT TEDS

1000000154 = Dependent1000000155 = Homeless1000000605 = Shelter

evaemployment Employment Status nvarchar (10) 1000000143 = Employed Full Time NOT TEDS1000000144 = Employed Part Time1000000145 = Occasional / Seasonal Worker1000000146 = Unemployed1000000147 = Homemaker1000000148 = Student1000000149 = Retired 1000000150 = Institutional Inmate1000000151 = Disabled1000000152 = Other

evalsed Co-Occurring Disorder nvarchar (1) N = No NOT TEDSY = Yes

EVALUATION FORM



Data Element Description Data Type Value Label TEDS DATA Coding/Remarksevaassigned Assigned Counselor nvarchar (6) Note: Table lookup too long and constantly change. NOT TEDSevauseMeth nvarchar (10) N = No NOT TEDS

Y = Yesevadrug1 nvarchar (10) 1000000105 = None NOT TEDS

1000000106 = Heroin1000000107 = Non-Rx Methadone1000000108 = Other Opiates and Synthetics1000000109 = Alcohol1000000110 = Barbiturates1000000111 = Other Sedatives or Hypnotics1000000112 = Amphetamines1000000113 = Cocaine1000000114 = Marijuana / Hashish1000000115 = Hallucinogens1000000116 = Inhalants1000000117 = Over-the-Counter1000000118 = Tranquilizers1000000119 = Tobacco1000000120 = PCP1000000121 = Other Stimulants1000000122 = Benzodiazepines1000000123 = Methamphetamines1000000578 = Oxycontin1000000579 = Ecstasy1000000580 = GHB 1000000124 = Gambling1000000606 = SOMA1000000125 = Other

evadrug1freq Frequency of Use (Primary) nvarchar (10) 1000000099 = No Use During Past Month NOT TEDS1000000607 = No Use During Treatment1000000100 = One to Three Times in Past Month1000000101 = One to Two Times Per Week1000000102 = Three to Six Times per Week1000000103 = Daily1000000582 = Not Applicable

evadrug1method nvarchar (10) 1000000292 = Oral NOT TEDS1000000293 = Injection1000000294 = Smoking1000000295 = Inhalation1000000296 = Other1000000297 = None Reported1000000582 = Not Applicable

evadrug2 nvarchar (10) 1000000105 = None NOT TEDS1000000106 = Heroin1000000107 = Non-Rx Methadone1000000108 = Other Opiates and Synthetics1000000109 = Alcohol1000000110 = Barbiturates

Use of Methadone as Part of TX Plan


Abuse/Addiction Type (Primary)

Route of Administration (Primary)



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000111 = Other Sedatives or Hypnotics1000000112 = Amphetamines1000000113 = Cocaine1000000114 = Marijuana / Hashish1000000115 = Hallucinogens1000000116 = Inhalants1000000117 = Over-the-Counter1000000118 = Tranquilizers1000000119 = Tobacco1000000120 = PCP1000000121 = Other Stimulants1000000122 = Benzodiazepines1000000123 = Methamphetamines1000000578 = Oxycontin1000000579 = Ecstasy1000000580 = GHB 1000000124 = Gambling1000000606 = SOMA1000000125 = Other

evadrug2freq nvarchar (10) 1000000099 = No Use During Past Month NOT TEDS1000000607 = No Use During Treatment1000000100 = One to Three Times in Past Month1000000101 = One to Two Times Per Week1000000102 = Three to Six Times per Week1000000103 = Daily1000000582 = Not Applicable


evadrug3 nvarchar (10) 1000000105 = None NOT TEDS1000000106 = Heroin1000000107 = Non-Rx Methadone1000000108 = Other Opiates and Synthetics1000000109 = Alcohol1000000110 = Barbiturates1000000111 = Other Sedatives or Hypnotics1000000112 = Amphetamines1000000113 = Cocaine1000000114 = Marijuana / Hashish1000000115 = Hallucinogens1000000116 = Inhalants1000000117 = Over-the-Counter1000000118 = Tranquilizers1000000119 = Tobacco






Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000120 = PCP1000000121 = Other Stimulants1000000122 = Benzodiazepines1000000123 = Methamphetamines1000000578 = Oxycontin1000000579 = Ecstasy1000000580 = GHB 1000000124 = Gambling1000000606 = SOMA1000000125 = Other

evadrug3freq Frequency of Use (Tertiary) nvarchar (10) 1000000099 = No Use During Past Month NOT TEDS1000000607 = No Use During Treatment1000000100 = One to Three Times in Past Month1000000101 = One to Two Times Per Week1000000102 = Three to Six Times per Week1000000103 = Daily1000000582 = Not Applicable


ticclient Client nvarchar (10) Auto-Generated from Registry Info NOT TEDSadmcasenumber Case Number nvarchar (9) Auto-Generated from Initial Interview NOT TEDSadmfacility Facility nvarchar (50) Auto-Generated from Initial Interview NOT TEDSticdate Service Ticket Date smalldatetime User Input NOT TEDS

ticprovider Provider nvarchar (255)

Note: Table lookup too long and constantly change. NOT TEDS

ticclienttype Client Type nvarchar (10) 1000000352 = Primary Client/Patient NOT TEDS1000000353 = Parent(s) Collateral(s)1000000354 = Spouse Collateral1000000355 = Child Collateral1000000356 = Other Relative1000000357 = Non-Relative Collateral1000000358 = Rep of Other Organization1000000359 = Prim & Signif Others (Deleted as of 03/2006)1000000360 = Other

ticservice1 Service nvarchar (6) 100001 = Contact Only NOT TEDS100002 = Individual Ser/Int100003 = Group Screening100004 = Collateral Counseling/Consult100005 = Psychosocial Eval100006 = Psychiatric Eval


SERVICE TICKETS FORM



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks100007 = Psychological Eval100008 = Physical Eval100009 = Other Evaluation100010 = Medical History100011 = Ind Ther/Couns100012 = Group Ther/Couns100013 = Family Ther/Couns100014 = CPL Ther/Couns100015 = Recreational/Art Ther100016 = TB Service100017 = Child Care100018 = Lab Work100019 = Medication Mgt100020 = Medication Inj100021 = HIV Service100022 = Educational Group100023 = Drug Screening Collection100024 = Antabuse Monitoring100025 = Methadone Monitoring100026 = STD Service (Other than HIV)100027 = Alternative Activity100028 = Transportation100029 = Other100030 = 24 Hour Facility Census100031 = Breath Analysis100038 = Group Service Co-Leadership100040 = Negative pregnancy test and pretest counseling100041 = Positive preg test with pre and posttest couns100042 = No preg test: edu or couns sess for preg women100051 = Client refused pregnancy testing

tictaskhours1 Hours nvarchar (2) 0 NOT TEDS12345678

tictaskminutes1 Minutes nvarchar (2) 00 NOT TEDS0510152025303540



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks455055

ticprogramelement Modality nvarchar (10) 1000000184 = Outpatient NOT TEDS1000000185 = IOP - Day1000000524 = IOP - Evening1000000186 = Inpatient

ticprogramelementnew Program Element nvarchar (10) 1000000525 = DWI - 1st or 2nd NOT TEDS1000000526 = DWI - 3rd 1000000527 = DWI - 4th +1000000528 = Gambling1000000529 = Drug Court1000000530 = FITAP1000000531 = Not Applicable1000000532 = DWI - 5th or more (Deleted as of 03/2006)

ticgroup Group Name nvarchar (6) Note: Table lookup too long and constantly change. NOT TEDSticnumberattended Number Attended nvarchar (2) User Input NOT TEDSticservicelocale Service Locale nvarchar (10) 1000000229 = Same Facility NOT TEDS

1000000230 = Cmty All Prog not active1000000231 = Cmty Sup Res not active1000000232 = Other SNF/ICF not active1000000233 = Pub Gen Hosp not active1000000234 = Other Gen Hosp not active1000000235 = ICF/MR not active1000000236 = Other, MH/SA Org not active1000000237 = School not active1000000238 = Corr/Law Enf Fac not active1000000239 = Home Visit not active1000000240 = Non-Fac Hrs Phone not active1000000241 = Outreach Clinic not active1000000242 = Detox Unit not active1000000244 = Other Tri-Med not active1000000245 = Other

tictimeperiod Time of Day nvarchar (10) 1000000224 = AM Hours NOT TEDS1000000225 = PM Hours1000000226 = Evening1000000227 = Non-Facility Hours1000000228 = Intermittent

ticcommunitycollab Community Collaboration nvarchar (10) 1000000176 = ISC NOT TEDS Deleted as of1000000177 = School Coalition March 20061000000178 = Inservice / Workshop1000000179 = Family Advocacy1000000180 = Youth Advocacy1000000181 = Management Meetings1000000496 = Not applicable

ticappointtmentstatus Appointment Status nvarchar (10) 1000000347 = No Show NOT TEDS Deleted as of1000000348 = Cancelled By Client March 20061000000349 = Cancelled By Provider



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000350 = Kept Scheduled Appointment1000000351 = Kept Unscheduled Appointment

ticemergency Emergency on Call nvarchar (10) 1000000219 = Not Emergency NOT TEDS Deleted as of1000000220 = Emergency March 2006

ticrecordtype Record Type nvarchar (2) X NOT TEDS Deleted as ofC March 2006

admclient Client nvarchar (10) Auto-Generated from Registry Info NOT TEDSadmcasenumber Case Number nvarchar (9) Auto-Generated from Initial Interview NOT TEDSadmtermdate Termination Date smalldatetime User Input TEDS - Date of Discharge (DIS 9) TEDS - DIS 9

admtermreason nvarchar (10)1000000417 = Completed Program, No further tx required

TEDS - Reason for Discharge, Transfer or Discontinue of Treatment (DIS 10)

TEDS - DIS 10

1000000418 = Client Referred Elsewhere 01 = Treatment Completed Not Active Since1000000419 = Completed Program, Appropriate Referral N/A (Not Active) 02 = Left Against Professional Advice January 2010

SEE 1000000420 = Appropriate Service N/A Within Facility (Not Active) 03 = Terminated by FacilityREVISIONS 1000000421 = Further Tx Needed, Reject by Client 04 = Transferred to Another Substance Abuse

BELOW 1000000422 = Client Died Treatment Program or Facility| 1000000423 = Client Moved, Contact N/A 14 = Transferred to Another Substance Abuse| 1000000424 = Client Administratively Discharged Treatment Prog. or Facility, but did not report| 1000000425 = Client Incarcerated, N/A for Tx (Not Active since 03/2006) 05 = Incarcerated| 1000000595 = Treatment Interrupted due to Natural Disaster 06 = DeathV 1000000611 = Completed Tx Program, Client referred for additional tx 07 = Other

1000000612 = Client incarcerated 08 = Unknownadmtermreason nvarchar (10) TEDS - Reason for Discharge, Transfer or Discontinue

of Treatment (DIS 10)TEDS - DIS 10

1000000417 = Completed Program, No further tx required 01 = Treatment Completed

1000000623 = Completed Tx, Client referred to next LOC04 = Transferred to Another Substance Abuse Treatment Program or Facility

1000000624 = Completed Tx, Client referred to next LOC, but rejected by Ct 02 = Left Against Professional Advice

1000000625 = Appropriate services not available, Client referred elsewhere04 = Transferred to Another Substance Abuse Treatment Program or Facility

1000000626 = Appropriate services not avail, Client referred elsewhere but rejected14 = Transferred to Another Substance Abuse Treatment Prog. Or Facility, but did not report

1000000424 = Client Administratively Discharged 03 = Terminated by Facility1000000421 = Client left TX prior to completion, Furthur TX needed, Rejected by Ct 02 = Left Against Professional Advice1000000422 = Client Died 06 = Death1000000595 = Treatment Interrupted due to Natural Disaster 07 = Other1000000612 = Client incarcerated 05 = Incarcerated1000000423 = Client Moved, Contact N/A 07 = Other

admtermarrest Arrests in 30 Days Prior to Termination nvarchar (2) User Input TEDS - Number of Arrests in 30 Days Prior to Discharge (DIS 26)

TEDS - DIS 26

00 - 96 = Number of Arrest(s) 00 - 96 = Number of Arrest(s)97 = Unknown 97 = Unknown

admTermArrestsDuring Was the arrest due to behavior nvarchar (1) N=No NOT TEDSin this treatment episode Y = Yes

Reason for transfer/termination

Reason for transfer/termination

TERMINATION FORM



Data Element Description Data Type Value Label TEDS DATA Coding/RemarksadmTermFreqAttn Self Help Activities 30 Days Prior to

Dischargenvarchar (10) TEDS - Frequency of Attendance at Self-Help

Programs in 30 Days Prior to Discharge (DIS 27)TEDS - DIS 27

1000000628 = No attendance in the past month 01 = No attendance in past month1000000635 = 1-3 times in past month 02 = 1-3 times in past month1000000636 = 4-7 times in past month 03 = 4-7 times in past month1000000637 = 8-15 times in past month 04 = 8-15 times in past month1000000638 = 16-30 times in past month 05 = 16-30 times in past month1000000639 = Some attendance, but frequency unknown 06 = Some attendance, but frequency unknown

admtermoutcome Treatment/Service Outcome nvarchar (10) 1000000426 = Significant Improvement NOT TEDS1000000427 = Marginal Improvement1000000428 = Insignificant Improvement (Not Active)1000000429 = No Improvement

admtermactivities Self-Help Activities nvarchar (10) 1000000430 = Actively Involved in Self-Help NOT TEDS Not Active1000000431 = Some Self-Help Since January 20101000000432 = Rejects Self-Help1000000582 = Not ApplicableUnknown

admtermpregnant Pregnant at Termination nvarchar (1) N = No NOT TEDSY = YesX = N/A (Auto-generated for Male client)

admtermmarital Marital Status nvarchar (10) 1000000164 = Never Married NOT TEDS1000000165 = Married1000000166 = Remarried1000000167 = Separated1000000168 = Divorced1000000169 = Widowed

admtermhousehold Household Composition nvarchar (10) 1000000156 = Adult Only NOT TEDS1000000157 = Adult - Relative1000000158 = Adult - Non-Relative1000000159 = Child - Both Parents1000000160 = Child - One Parent1000000161 = Child - Relatives / Not Parents1000000162 = Child - Foster Family1000000163 = Child - Non-Relative

admtermresidence Type of Residence nvarchar (10) TEDS - Living Arrangements at Discharge (DIS 23) TEDS - DIS 23

1000000153 = Independent 01 = Homeless1000000605 = Shelter 01 = Homeless1000000154 = Dependent 02 = Dependent Living1000000155 = Homeless 03 = Independent Living

admtermemployment Employment Status nvarchar (10) TEDS - Employment Status at Discharge (DIS 24) TEDS - DIS 241000000143 = Employed Full Time 01 = Full Time1000000144 = Employed Part Time 02 = Part Time1000000145 = Occasional / Seasonal Worker 03 = Unemployed1000000146 = Unemployed 04 = Not in Labor Force1000000147 = Homemaker 97 = Unknown1000000148 = Student1000000149 = Retired TEDS - Detailed Not In Labor Force (DIS 25) TEDS - DIS 25



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000150 = Institutional Inmate 01 = Homemaker1000000151 = Disabled 02 = Student1000000152 = Other 03 = Retired

04 = Disabled05 = Inmate of Institution (Prison)06 = Other96 = Not Applicable97 = Unknown

admtermmonthlyincome Integer User input NOT TEDS

admtermincomedependents

Dependents on Above Income Integer User Input NOT TEDS

admtermchilddependents Dependent Children Integer User Input NOT TEDS

admtermedcurrent Current Emotional Disorder nvarchar (10) 1000000376 = No history NOT TEDS1000000375 = Yes - has history

admtermservicetype Service Type at Discharge nvarchar (10) TEDS - Type of Services at Discharge (DIS 7) TEDS - DIS 71000000560 = Intensive Outpatient 01 = Detoxification, 24-Hour Service ,1000000561 = Non-Intensive Outpatient Hospital Inpatient1000000562 = Inpatient - Adult - Short Term ((30 days) 05 = Rehabilitation/Residential 1000000569 = Social Detoxification Long Term (More than 30 Days)1000000570 = Residential - Adult/Adolescent - Long Term (>30 days) 06 = Ambulatory - Intensive-Outpatient

07 = Ambulatory - Non-Intensive Outpatient08 = Ambulatory - Detoxification09 = Unknown

admtermlastcontact Last Contact Date smalldate (4) System Auto-Generated TEDS - Date of Last Contact (DIS 8) TEDS - DIS 8Reason for contact at Discharge nvarchar (10) 1000000191 = Evaluation Only TEDS - DIS 6

1000000192 = Non-Crisis, Counsel - Self1000000193 = Non-Crisis, Counsel - Collateral 1 = Yes1000000194 = Crisis Intervention - Self 2 = No1000000195 = Crisis Intervention - Collateral1000000544 = Screening Only

admTermComments Comments ntext (16) User Input NOT TEDSadmtermdrug1 Abuse/Addiction Type (Prim) nvarchar (10)

1000000105 = NoneTEDS - Substance Problem at Discharge, Primary

(DIS 21 A)TEDS - DIS 21 (A)

1000000106 = Heroin 01 = None1000000107 = Non-Rx Methadone 02 = Alcohol1000000108 = Other Opiates and Synthetics 03 = Cocaine / Crack1000000109 = Alcohol 04 = Marijuana / Hashish1000000110 = Barbiturates 05 = Heroin1000000111 = Other Sedatives or Hypnotics 06 = Non-Prescription Methadone1000000112 = Amphetamines 07 = Other Opiates and Synthetics

Average Gross Monthly Income

TEDS - Co-Dependent/Collateral at Discharge (DIS 6)

admTermContactReason



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000113 = Cocaine 08 = PCP1000000114 = Marijuana / Hashish 09 = Other Hallucinogens1000000115 = Hallucinogens 10 = Methamphetamine1000000116 = Inhalants 11 = Other Methamphetamines1000000117 = Over-the-Counter 12 = Other Stimulants1000000118 = Tranquilizers 13 = Benzodiazepines1000000119 = Tobacco 14 = Other Non-Benzodiazepine Tranquilizer1000000120 = PCP 15 = Barbiturates1000000121 = Other Stimulants 16 = Other Non-Barbiturate Sedatives or1000000122 = Benzodiazepines Hypnotics1000000123 = Methamphetamines 17 = Inhalants1000000578 = Oxycontin 18 = Over-the-Counter1000000579 = Ecstasy 20 = Other1000000580 = GHB 97 = Unknown1000000124 = Gambling1000000606 = SOMA1000000125 = Other

admtermdrug1freq Frequency of Use (Prim) nvarchar (10) TEDS - Frequency of Use at Discharge, Primary TEDS - DIS 22 (A)1000000099 = No Use During Past Month 01 = No Use During Past Month1000000607 = No Use During Treatment 01 = No Use During Past Month1000000100 = One to Three Times in Past Month 02 = One to Three Times in Past Month1000000101 = One to Two Times Per Week 03 = One to Two Times Per Week1000000102 = Three to Six Times per Week 04 = Three to Six Times per Week1000000103 = Daily 05 = Daily1000000582 = Not Applicable 96 = Not Applicable

admtermdrug1method Route of Administration (Prim) nvarchar (10) NOT TEDS1000000292 = Oral1000000293 = Injection1000000294 = Smoking1000000295 = Inhalation1000000296 = Other1000000582 = Not Applicable1000000297 = None Reported

admtermdrug2 nvarchar (10)1000000105 = None

TEDS - Substance Problem at Discharge, Secondary (DIS 21 B)

TEDS - DIS 21 (B)

1000000106 = Heroin 01 = None1000000107 = Non-Rx Methadone 02 = Alcohol1000000108 = Other Opiates and Synthetics 03 = Cocaine / Crack1000000109 = Alcohol 04 = Marijuana / Hashish1000000110 = Barbiturates 05 = Heroin1000000111 = Other Sedatives or Hypnotics 06 = Non-Prescription Methadone1000000112 = Amphetamines 07 = Other Opiates and Synthetics1000000113 = Cocaine 08 = PCP1000000114 = Marijuana / Hashish 09 = Other Hallucinogens1000000115 = Hallucinogens 10 = Methamphetamine1000000116 = Inhalants 11 = Other Methamphetamines1000000117 = Over-the-Counter 12 = Other Stimulants1000000118 = Tranquilizers 13 = Benzodiazepines




Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000119 = Tobacco 14 = Other Non-Benzodiazepine Tranquilizer1000000120 = PCP 15 = Barbiturates1000000121 = Other Stimulants 16 = Other Non-Barbiturate Sedatives or1000000122 = Benzodiazepines Hypnotics1000000123 = Methamphetamines 17 = Inhalants1000000578 = Oxycontin 18 = Over-the-Counter1000000579 = Ecstasy 20 = Other1000000580 = GHB 97 = Unknown1000000124 = Gambling1000000606 = SOMA1000000125 = Other

admtermdrug2freq nvarchar (10) TEDS - Frequency of Use at Discharge, Secondary (DIS 22 B)

TEDS - DIS 22 (B)

1000000099 = No Use During Past Month 01 = No Use During Past Month1000000607 = No Use During Treatment 01 = No Use During Past Month1000000100 = One to Three Times in Past Month 02 = One to Three Times in Past Month1000000101 = One to Two Times Per Week 03 = One to Two Times Per Week1000000102 = Three to Six Times per Week 04 = Three to Six Times per Week1000000103 = Daily 05 = Daily1000000582 = Not Applicable 96 = Not Applicable

admtermdrug2method nvarchar (10) 1000000292 = Oral NOT TEDS1000000293 = Injection1000000294 = Smoking1000000295 = Inhalation1000000296 = Other1000000297 = None Reported1000000582 = Not Applicable

admtermdrug3 nvarchar (10)1000000105 = None

TEDS - Substance Problem at Discharge, Tertiary (DIS 21 C)

TEDS - DIS 21 (C)

1000000106 = Heroin 01 = None1000000107 = Non-Rx Methadone 02 = Alcohol1000000108 = Other Opiates and Synthetics 03 = Cocaine / Crack1000000109 = Alcohol 04 = Marijuana / Hashish1000000110 = Barbiturates 05 = Heroin1000000111 = Other Sedatives or Hypnotics 06 = Non-Prescription Methadone1000000112 = Amphetamines 07 = Other Opiates and Synthetics1000000113 = Cocaine 08 = PCP1000000114 = Marijuana / Hashish 09 = Other Hallucinogens1000000115 = Hallucinogens 10 = Methamphetamine1000000116 = Inhalants 11 = Other Methamphetamines1000000117 = Over-the-Counter 12 = Other Stimulants1000000118 = Tranquilizers 13 = Benzodiazepines1000000119 = Tobacco 14 = Other Non-Benzodiazepine Tranquilizer1000000120 = PCP 15 = Barbiturates1000000121 = Other Stimulants 16 = Other Non-Barbiturate Sedatives or1000000122 = Benzodiazepines Hypnotics1000000123 = Methamphetamines 17 = Inhalants1000000578 = Oxycontin 18 = Over-the-Counter






Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000579 = Ecstasy 20 = Other1000000580 = GHB 97 = Unknown1000000124 = Gambling1000000606 = SOMA1000000125 = Other

admtermdrug3freq Frequency of Use (Tertiary) nvarchar (10) TEDS - Frequency of Use at Discharge, Tertiary (DIS 22 C)

TEDS - DIS 22 (C)

1000000099 = No Use During Past Month 01 = No Use During Past Month1000000607 = No Use During Treatment 01 = No Use During Past Month1000000100 = One to Three Times in Past Month 02 = One to Three Times in Past Month1000000101 = One to Two Times Per Week 03 = One to Two Times Per Week1000000102 = Three to Six Times per Week 04 = Three to Six Times per Week1000000103 = Daily 05 = Daily1000000582 = Not Applicable 96 = Not Applicable

admterm3method nvarchar (10) 1000000292 = Oral NOT TEDS1000000293 = Injection1000000294 = Smoking1000000295 = Inhalation1000000296 = Other1000000297 = None Reported1000000582 = Not Applicable

profacility Facility nvarchar (6) Note: Table lookup too long and constantly change. NOT TEDSprolastname Last Name nvarchar (30) User Input NOT TEDSprofirstname First Name nvarchar (30) User Input NOT TEDSpromiddle Middle Name nvarchar (1) User Input NOT TEDSproemployment Employment Status nvarchar (10) 1000000093 = Volunteer NOT TEDS

1000000094 = Student, Trainee, Resident, Intern1000000095 = Contractor (Division of Administration Contract)1000000096 = Part Time Civil Servant1000000097 = Full Time Civil Servant1000000098 = Employees Paid by Other Agencies

prodiscipline Discipline nvarchar (10) 1000000328 = Psychiatrist NOT TEDS1000000329 = Other Physician1000000330 = Psychologist1000000331 = Social Worker1000000332 = Registered Nurse1000000333 = Practical Nurse1000000334 = School Teacher1000000335 = Licensed Substance Abuse Counselor1000000336 = Counselor In Training1000000337 = Phlebotomist1000000338 = Recreation/Art Therapist1000000339 = Other Activity Therapist or Assistant/Aide1000000340 = Vocational Rehabilitation Counselor1000000341 = Alcohol/Drug Counselor

PROVIDER TABLE




Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000342 = Other Professional Counselors1000000343 = Other Paraprofessional Worker1000000344 = Physical Health Professional1000000345 = Pharmacist1000000346 = Other

proeducation Educational Level nvarchar (2) User Input NOT TEDSproanniversary Anniversary Date smalldatetime User Input NOT TEDS

protermdate Termination Date smalldatetime User Input NOT TEDS

proclass Class Code nvarchar (4) User Input NOT TEDSprohours Hours/Week nvarchar (2) User Input NOT TEDSprosalary Salary/Hour nvarchar (2) User Input NOT TEDSproactive Active nvarchar (1) N = No NOT TEDS

Y = Yes

facnumber Facility Number nvarchar (5) User Input (OAD-HQ assigned numbers) NOT TEDSfacname Facility Name nvarchar (50) Note: Table lookup too long and constantly change. NOT TEDSfacaddress Address nvarchar (40) User Input NOT TEDSfaccity City nvarchar (30) User Input NOT TEDSfaczip Zip nvarchar (10) User Input NOT TEDSfacphone Phone nvarchar (20) User Input NOT TEDSfaccontact Contact Name nvarchar (30) User Input NOT TEDSfacregion Region nvarchar (10) 100001 = Region 1 NOT TEDS

100002 = Region 2 / CASHD100003 = Region 3100004 = Region 4100005 = Region 5100006 = Region 6100007 = Region 7100008 = Region 8100009 = Region 9100010 = Region 10100011 = Headquarters

facmodality Modality nvarchar (10) 1000000069 = N/A NOT TEDS1000000070 = A. P. Inpatient1000000071 = C. B. Adolescent1000000072 = Drug Court1000000073 = Halfway House1000000074 = Inpatient1000000075 = M. Detox1000000076 = Outpatient1000000077 = Prevention1000000078 = Resident1000000079 = S. Detox1000000522 = Intensive Outpatient1000000523 = Gambling Intensive Outpatient

FACILITY TABLE



Data Element Description Data Type Value Label TEDS DATA Coding/Remarks1000000533 = Board and Care1000000538 = Halfway House/TANF1000000539 = Gambling Inpatient1000000540 = Gambling Outpatient1000000541 = M.S. Detox

facprogram Program nvarchar (10) 1000000003 = Contract NOT TEDS1000000004 = State

facbeds Number of Beds Integer User Input NOT TEDSfacteds N-SSATS # nvarchar (20) User Input NOT TEDSfacactive Active nvarchar (1) N = No NOT TEDS

Y = Yes

Sheet1

registry info form · 2016. 12. 20. · 1000000255 = inpatient - adult - short term (

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