Appendix - Attachment 9 - OE SPARS CSAT GPRA Codebook.xlsx
XLSX spreadsheet 141 KB Posted
- Solicitation number
- 1626-009
- Issued by
- Anchorage Municipality, Alaska
About this file
This document is a CSAT (Center for Substance Abuse Treatment) GPRA (Government Performance and Results Act) Codebook for a standardized client-level interview tool used in substance abuse treatment and recovery programs. The codebook provides comprehensive instructions and field definitions for a detailed data collection instrument that tracks client demographics, substance use, treatment services, medical history, and program outcomes across multiple interview types including intake, follow-up, and discharge. The tool is designed to be used by grantees and service providers to systematically record client information and measure program effectiveness.
The codebook contains extensive metadata for each data field, including batch upload and download specifications, tool sections, field names, question numbers, value definitions, data types, and validation rules. It covers a wide range of service categories such as case management, medical services, treatment modalities, recovery support, and education services. The tool captures detailed information about client diagnoses, medication-assisted treatments for various substance use disorders (opioid, alcohol, stimulant, and tobacco), medication adherence, clinical interventions, and client achievements in areas like employment, education, and housing. The July 2023 version represents an updated approach to tracking and evaluating substance abuse treatment programs, with specific guidance for data entry, validation, and reporting.
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Explanation
| Explanation of CSAT GPRA Codebook Elements | Description for the decision process flowchart depicted below is located in cell B6. |
| Note: This CSAT GPRA Codebook is intended to aid grantees in understanding the current GPRA tool used for client-level interviews conducted on 1/21/2023 and forward. While the codebook is as accurate as possible at this time, additional updates may be required as a result of changes identified by users of data entry and batch upload processes. It is expected that any changes will be minor. Please check the SPARS Resource site to ensure you are working with the most current version of the codebook. |
Overview: This CSAT GPRA Codebook contains information about the fields available for batch upload and data download for the current GPRA tool used for client-level interviews conducted on 1/21/2023 and forward. Grantees should refer to the previous iteration of the codebook for expired GPRA tool data. This codebook should be used only for the current GPRA tool.
Codebook columns: Columns A and B indicate if a field is used for batch upload and/or appears in data download. Grantees should filter based on these columns to determine all the fields needed for batch upload and all the fields to expect in a data download.
Column C indicates the section of the GPRA tool in which the field appears.
Column D indicates the field name that should be used for batch upload and the name that appears in data download. Note that not all field names appear in the tool as some are system derived.
Column E indicates the question number from the GPRA tool associated with the field.
Column F indicates the question text from the GPRA tool associated with the field.
Columns G and H should be referenced to determine the valid values that can be used for batch upload and the valid values to expect when viewing a data download file.
Column I indicates the data type of the field.
Column J indicates additional notes related to warnings, skip logic, and conditions for the field.
Codebook rows: There is a row in the codebook for every field that is required when batch uploading data or that will appear in a download of current GPRA tool data.
Important:
B12 Planned Services and H8_2a-d display batch upload and data download information On separate rows.
B12 Planned Services data output in a download file populates under the same field names as K1 Services Received.
H8_2a-d data output in a download file populates under the same field names as H3_2a-d.
When reviewing a download of expired GPRA tool data , the previous iteration of the CSAT GPRA tool should be referenced. blank
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| CSAT GPRA Codebook | |
| End of worksheet |
Version: July 2023 &A &P
Codebook
| CSAT GPRA Tool Codebook (June 2025) | ||||||
| Batch Upload Field | Data Download Field | Tool Section | Field Name | Question | ||
| Number | Question and/or Description | Value Definitions (Batch Upload) | Value Definitions (Data Download) | Data Type | Warning Edits / Skip Logic | |
| No | Yes | A. RECORD MANAGEMENT | Region | N/A | Region associated with the grant organization under which the client record falls | |
| . | 1 = CT, ME, MA, NH, RI, VT |
2 = NJ, NY, PR, VI
3 = DE, DC, MD, PA, VA, WV
4 = AL, FL, GA, KY, MS, NC, SC, TN
5 = IL, IN, MI, MN, OH, WI
6 = AR, LA, NM, OK, TX
7 = IA, KS, MO, NE
8 = CO, MT, ND, SD, UT, WY
9 = AZ, CA, HI, NV, AS, MP, FM, GU, MH, PW
10 = AK, ID, OR, WA Text(2) AUTOFILL - System Derived Each region consists of a set of states/territories
| No | Yes | A. RECORD MANAGEMENT | StateCode | N/A | State associated with the grant organization under which the client record falls | . | Two letter postal code abbreviation | |||
| (Three letters may be used for certain US territories.) | Text(2) | AUTOFILL - System Derived | ||||||||
| Yes | Yes | A. RECORD MANAGEMENT | GrantNo | N/A | Contract/Grant ID | Assigned by CSAT | Assigned by CSAT | Numeric | . | |
| No | Yes | A. RECORD MANAGEMENT | GrantInactFlag | N/A | Grant Status (active or inactive) | . | 0 = Active | |||
| 1 = Inactive | Numeric | AUTOFILL - System Derived |
A grant is Active beginning on it's Start Date; a grant becomes inactive 30 days after the grant end date.
| No | Yes | A. RECORD MANAGEMENT | ClientIntakeID | N/A | Unique identifier assigned by system per client and episode of care | . | N/A – internal record ID | Numeric | AUTOFILL - System Derived |
| No | Yes | A. RECORD MANAGEMENT | IntakeDate | N/A | Date of Intake Interview | . | MM/DD/YYYY | Date | AUTOFILL - System Derived |
*copied from InterviewDate where InterviewType=1 No Yes A. RECORD MANAGEMENT IntakeSeqNum N/A Intake sequence number (within client). . N/A – internal record ID Numeric AUTOFILL - System Derived An intake sequence number is given to each intake. The default value is 1. Some clients enter the program more than once. Each time they enter and take a new intake their sequence number increases sequentially. The highest sequence number (IntakeSeqNum) within client should point to the current/active intake.
| Yes | Yes | A. RECORD MANAGEMENT | ClientID | N/A | Unique identifier for a person within a grant. | |
| Assigned by grantee. | Grant-generated ID number | Grant-generated ID number | Alphanumeric(15) | SBIRT ClientID Only: |
Column 1: Values for Sample participation code as follows:
"1" - Client not sampled for follow-up "3" - Client sampled for follow-up and agreed to participate Columns 2-13: ClientID assigned by grant Columns 14-15: Random sample criteria Yes Yes A. RECORD MANAGEMENT ClientDescripTreat N/A Client description by grant type: Treatment 1 = Yes 0 = No -1 = Not Applicable 1 = Yes 0 = No -1 = Not Applicable Numeric At Intake, one of ClientDescripTreat and ClientDescripRecover must be 1 and the other must be 0
At FUP and Discharge, must be -1 (NA) Yes Yes A. RECORD MANAGEMENT ClientDescripRecov N/A Client description by grant type: Recovery 1 = Yes 0 = No -1 = Not Applicable 1 = Yes 0 = No -1 = Not Applicable Numeric At Intake, one of ClientDescripTreat and ClientDescripRecover must be 1 and the other must be 0
At FUP and Discharge, must be -1 (NA) Yes Yes A. RECORD MANAGEMENT InterviewType N/A Interview Type 1 = Intake 2 = 6-month follow-up 4 = 3-month follow-up 5 = Discharge 1 = Intake 2 = 6-month follow-up 4 = 3-month follow-up
| 5 = Discharge | Numeric | . | ||||||||
| Yes | Yes | A. RECORD MANAGEMENT | InterviewDate | N/A | The date the GPRA interview was completed. (If an interview was not conducted, do not enter a date.) | MM/DD/YYYY | MM/DD/YYYY | Date | Follow-up interview date must be > intake interview date for the same episode of care when interview is conducted. |
Discharge date must be > or = intake interview date for same episode of care when interview is conducted.
For SBIRT programs, Follow-up interview date must be > intake interview date for same class code when interview is conducted. Discharge date must be > or = intake interview date for same class code when interview is conducted.
The GPRA intake/baseline interview date will determine when subsequent follow-up interviews are due. It is also used to calculate the project’s follow-up rate, based on how many of the follow-up interviews that were due have actually been completed. The GPRA intake/baseline interview date combined with the discharge date is used to calculate the client’s length of stay.
No Yes A. RECORD MANAGEMENT CalculatedInterviewDate N/A Date that is used to assign fiscal year . MM/DD/YYYY Date AUTOFILL - System Derived
For Intake/FUP/Discharge records:
If InterviewDate is valued, then CalculatedInterviewDate = InterviewDate
For FUP records:
If InterviewDate is empty, then CalculatedInterviewDate = IntakeDate + (3*30) days for 3mFUP
OR
IntakeDate + (6*30) days for 6mFUP
OR
IntakeDate + (12*30) days for 12mFUP
For Discharge records:
If InterviewDate is empty, then CalculatedInterviewDate = DischargeDate
| No | Yes | A. RECORD MANAGEMENT | InterviewCreateDate | N/A | Date interview was entered in the database | . | MM/DD/YYYY | Date | AUTOFILL - System Derived | |
| No | Yes | A. RECORD MANAGEMENT | InterviewUpdateDate | N/A | Date record was last updated | . | MM/DD/YYYY | Date | AUTOFILL - System Derived | |
| No | Yes | A. RECORD MANAGEMENT | InactFlag | N/A | Interview Status (active or inactive) | . | 0 = Active | |||
| 1 = Inactive | Numeric | AUTOFILL - System Derived |
A client can have multiple intakes - the most current intake is "active" (inactflag='0') and the rest are set to "inactive" (inactflag='1').
For regular Services: When a new Intake is added all existing interviews are marked inactive.
For SBIRT grants when a new SBIRTIntake is added all existing interviews with the same SBIRTClassCode are marked inactive.
No Yes A. RECORD MANAGEMENT FFY N/A Federal Fiscal Year . Federal Fiscal Year Numeric AUTOFILL - System Derived Based on InterviewDate calculated separately for each interview; if no interview conducted, based on date interview entered database.
No Yes A. RECORD MANAGEMENT Quarter N/A Federal Fiscal Year Quarter . 1 = October - December 2 = January - March 3 = April - June 4 = July - September Numeric AUTOFILL - System Derived Based on InterviewDate calculated separately for each interview; if no interview conducted, based on date interview entered database.
No Yes A. RECORD MANAGEMENT Month N/A Month Interview took place . 01 - 12 = Jan - Dec Numeric AUTOFILL - System Derived Based on InterviewDate calculated separately for each interview; if no interview conducted, based on date interview entered database.
| Yes | Yes | A. RECORD MANAGEMENT | ConductedInterview | N/A | Did you conduct a follow-up/discharge interview? | 1 = Yes | |
| 0 = No | 1 = Yes | ||||||
| 0 = No | Numeric | At Intake, must = 1 |
Complete at Follow-Up/Discharge
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | BirthMonth | A1 | Date of Birth - Month only | 01 - 12 = Jan - Dec | 01 - 12 = Jan - Dec | Numeric | . |
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | BirthYear | A1 | Date of Birth - Year only | 1900 to (Current year less 10 years) | 1900 to (Current year less 10 years) | Numeric | . |
| No | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | Age | N/A | Calculated field - the difference between IntakeDate and BirthDate in years. | . | System calculated | Numeric | AUTOFILL - System Derived |
Calculated at Intake only.
No Yes A. RECORD MANAGEMENT - DEMOGRAPHICS AgeGroup N/A Calculated field based on Age. . 0 = Age 10 to 12 years old 1 = Age 13 to 17 years old 2 = Age 18 to 24 years old 3 = Age 25 to 34 years old 4 = Age 35 to 44 years old 5 = Age 45 to 54 years old 6 = Age 55 to 64 years old 7 = Age 65 years old or greater -9 = unable to calculate age Numeric AUTOFILL - System Derived Calculated at Intake only.
| No | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | Unavailable | A2 | Unavailable | N/A | N/A | N/A | N/A |
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | HispanicLatino | A3 | Are you Hispanic, Latino/a, or of Spanish origin? | ||||
| 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If the client responds that he/she is not Hispanic or Latino, check “no” and continue with question A4. If the client refuses to answer check “Refused” and continue with question A4. If the client responds that he/she is Hispanic or Latino, check “yes” and inquire about which ethnic group the client considers him/herself. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicCentralAmerican | A3a | What ethnic group do you consider yourself? You may indicate more than one. Central American. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicCuban | A3a | What ethnic group do you consider yourself? You may indicate more than one. Cuban | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicDominican | A3a | What ethnic group do you consider yourself? You may indicate more than one. Dominican. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicMexican | A3a | What ethnic group do you consider yourself? You may indicate more than one. Mexican. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicPuertoRican | A3a | What ethnic group do you consider yourself? You may indicate more than one. Puerto Rican. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicSouthAmerican | A3a | What ethnic group do you consider yourself? You may indicate more than one. South American. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicOther | A3a | What ethnic group do you consider yourself? You may indicate more than one. Other (Specify). | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data -1 = Not Applicable 1 = Yes 0 = No -7 = Refused -9 = Missing Data
| -1 = Not Applicable | Numeric | If HispanicLatino=1, then Ethnicity questions must be completed. If HispanicLatino=0 (No), -7 (Refused), or -9 (Missing), Ethnicity questions must be -1 (NA). If any Ethnicity field is -1 (NA), -7 (Refused), or -9 (Missing), then all must be. | ||||||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | EthnicOtherSpec | A3a | What ethnic group do you consider yourself? You may indicate more than one. Other Specify text response. | Text | Text | Character(50) | Must be completed if EthnicOther = 1, otherwise must be blank. | |
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceBlack | A4 | What is your race? You may indicate more than one. Black or African American. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceWhite | A4 | What is your race? You may indicate more than one. White. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceAmericanIndian | A4 | What is your race? You may indicate more than one. American Indian. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceAlaskaNative | A4 | What is your race? You may indicate more than one. Alaska Native. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceAsianIndian | A4 | What is your race? You may indicate more than one. Asian Indian. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceChinese | A4 | What is your race? You may indicate more than one. Chinese. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceFilipino | A4 | What is your race? You may indicate more than one. Filipino. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceJapanese | A4 | What is your race? You may indicate more than one. Japanese. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceKorean | A4 | What is your race? You may indicate more than one. Korean. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceVietnamese | A4 | What is your race? You may indicate more than one. Vietnamese. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceOtherAsian | A4 | What is your race? You may indicate more than one. Other Asian. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceNativeHawaiian | A4 | What is your race? You may indicate more than one. Native Hawaiian | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceGuamanianChamorro | A4 | What is your race? You may indicate more than one. Guamanian or Chamorro. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceSamoan | A4 | What is your race? You may indicate more than one. Samoan. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceOtherPacificIslander | A4 | What is your race? You may indicate more than one. Other Pacific Islander. | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceOther | A4 | What is your race? You may indicate more than one. Other (Specify). | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | If any Race field is -7 (Refused), or -9 (Missing), then all must be. | ||||||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RaceSpec | A4 | What is your race? You may indicate more than one. Other specify text. | Text | Text | Character(50) | Must be completed if RaceOther = 1, otherwise must be blank. | |
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | LangNotEnglishAtHome | A5 | Do you speak a language other than English at home? | 1 = Yes |
0 = No -1 = Not Applicable -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused -9 = Missing Data Numeric Complete for interview conducted in English. Valid values are 1/0/-7/-9.
If interview is conducted in Spanish, must be -1 (NA).
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS LangNotEnglishSpoken A5a [IF YES] What is this language? 1 = Spanish 2 = Other (Specify) -1 - Not Applicable -7 = Refused -9 = Missing Data 1 = Spanish 2 = Other (Specify) -1 - Not Applicable -7 = Refused -9 = Missing Data Numeric Complete for interview conducted in English.
Asked only if LangNotEnglishAtHome = 1, otherwise must be -1 (NA).
If interview is conducted in Spanish, must be -1 (NA).
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS LangNotEnglishSpokenSpec A5a If YES, what is this language? Other specify text. Text Text Character(50) Complete for interview conducted in English.
Must be completed if LangNotEnglishSpoken = 2, otherwise must be blank.
If interview is conducted in Spanish, must be blank.
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS LangNotSpanishAtHome A5 Do you speak a language other than Spanish at home? 1 = Yes 0 = No -1 = Not Applicable -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused -9 = Missing Data Numeric Complete for interview conducted in Spanish. Valid values are 1/0/-7/-9.
If interview is conducted in English, must be -1 (NA).
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS LangNotSpanishSpoken A5a [IF YES] What is this language? 1 = English 2 = Other (Specify) -1 = Not Applicable -7 = Refused -9 = Missing Data 1 = English 2 = Other (Specify) -1 = Not Applicable -7 = Refused -9 = Missing Data Numeric Complete for interview conducted in Spanish.
Asked only if LangNotSpanishAtHome = 1, otherwise must be -1 (NA).
If interview is conducted in English, must be -1 (NA).
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS LangNotSpanishSpokenSpec A5a [IF YES] What is this language? Text Text Character(50) Complete for interview conducted in Spanish.
Must be completed if LangNotSpanishSpoken = 2, otherwise must be blank.
If interview is conducted in English, must be blank.
| No | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | Unavailable | A6 | Unavailable | N/A | N/A | N/A | N/A |
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | RelationshipStatus | A7 | What is your relationship status? | 1 = Married |
2 = Single 3 = Divorced 4 = Separated 5 = Widowed 6 = In a relationship 7 = In multiple relationships -7 = Refused -9 = Missing Data 1 = Married 2 = Single 3 = Divorced 4 = Separated 5 = Widowed 6 = In a relationship 7 = In multiple relationships -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | . | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | Pregnant | A8 | Are you currently pregnant? | 1 = Yes |
0 = No -8 = Do not know -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -8 = Do not know -7 = Refused
| -9 = Missing Data | Numeric | . | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | Children | A9 | Do you have children? [Refers to children both living and/or who may have died] | 1 = Yes |
0 = No -7 = Refused -9 = Missing Data 1 = Yes 0 = No -7 = Refused
| -9 = Missing Data | Numeric | If Children <> 1, skip to question A10 | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | ChildrenUnder18Nr | A9a | How many children under the age of 18 do you have? | 0 - 99 = Children |
-7 = Refused -9 = Missing Data 0 - 99 = Children -7 = Refused
| -9 = Missing Data | Numeric | Skip (must be blank) if Children <> 1 | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | ChildrenCustody | A9b | Are any of your children, who are under the age of 18, living with someone else due to a court's intervention? | 1 = Yes |
0 = No -1 = Not Applicable -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | Skip if Children <> 1 or if ChildrenUnder18Nr <= 0. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | ChildrenCustodyNr | A9b | [IF YES] Number of children removed from client's care. | 1 - 99 = Children |
-7 = Refused -9 = Missing Data 1 - 99 = Children -7 = Refused -9 = Missing Data Numeric Skip (must be blank) if Children <> 1 or if ChildrenUnder18Nr <= 0 or if ChildrenCustody <= 0.
ChildrenCustodyNr must be <= ChildrenUnder18Nr.
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS ChildrenReunited A9c Have you been reunited with any of your children, under the age of 18, who have been previously removed from your care? 1 = Yes 0 = No -1 = Not Applicable -7 = Refused -9 = Missing Data 1 = Yes 0 = No -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | Skip if Children <> 1 or if ChildrenUnder18Nr <= 0 or if ChildrenCustody <= 0. | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | ChildrenReunitedNr | A9c | [IF YES] Number of children with whom the client has been reunited | 1 - 99 = Children |
-7 = Refused -9 = Missing Data 1 - 99 = Children -7 = Refused -9 = Missing Data Numeric Skip (must be blank) if Children <> 1 or if ChildrenUnder18Nr <= 0 or if ChildrenCustody <= 0 or if ChildrenReunited <> 1.
ChildrenReunitedNr must be <= ChildrenUnder18Nr.
Yes Yes A. RECORD MANAGEMENT - DEMOGRAPHICS MilitaryServed A10 Have you ever served in the Armed Forces, in the Reserves, in the National Guard, or in other Uniformed Services? [IF SERVED] What area, the Armed Forces, Reserves, National Guard, or other did you serve? 0 = No 1 = Yes, In the Armed Forces 2 = Yes, in the Reserves 3 = Yes, in the National Guard 4 = Yes, other Uniformed Services [includes NOAA, USPHS] -7 = Refused -9 = Missing Data 0 = No 1 = Yes, In the Armed Forces 2 = Yes, in the Reserves 3 = Yes, in the National Guard 4 = Yes, other Uniformed Services [includes NOAA, USPHS] -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | . | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | ServicesTravelTime | A11 | How long does it take you, on average, to travel to the location where you receive services provided by this grant? | 1 = Half an hour or less |
2 = Between half an hour and one hour 3 = Between one hour and one and a half hours 4 = Between one and a half hours and two hours 5 = Two hours or more -7 = Refused -9 = Missing Data 1 = Half an hour or less 2 = Between half an hour and one hour 3 = Between one hour and one and a half hours 4 = Between one and a half hours and two hours 5 = Two hours or more -1 = Not Applicable -7 = Refused
| -9 = Missing Data | Numeric | . | |||||
| Yes | Yes | A. RECORD MANAGEMENT - DEMOGRAPHICS | Sex | A12 | What is your sex? [OPTIONAL] | 1 = Male |
2 = Female
| 1 = Male | |||||||
| 2 = Female | Numeric | . | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholDays | B1_a1 | The number of days, in the past 30 days, that the client reports using a substance. Alcohol. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES AlcoholRoute B1_a1 The Route by which the substance is used. Alcohol. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholOther1Days | B1_a2.o1 | The number of days, in the past 30 days, that the client reports using a substance. Other alcohol. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES AlcoholOther1Route B1_a2.o1 The Route by which the substance is used. Other alcohol. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | ||||||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholOther1Spec | B1_a2.o1 | The Route by which the substance is used. Other alcohol text. | Text | Text | Character(50) | Must be completed if AlcoholOther1Days > 0, otherwise must be blank. | |
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholOther2Days | B1_a2.o2 | The number of days, in the past 30 days, that the client reports using a substance. Other alcohol. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES AlcoholOther2Route B1_a2.o2 The Route by which the substance is used. Other alcohol. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | ||||||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholOther2Spec | B1_a2.o2 | The Route by which the substance is used. Other alcohol text. | Text | Text | Character(50) | Must be completed if AlcoholOther2Days > 0, otherwise must be blank. | |
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholOther3Days | B1_a2.o3 | The number of days, in the past 30 days, that the client reports using a substance. Other alcohol. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES AlcoholOther3Route B1_a2.o3 The Route by which the substance is used. Other alcohol. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | ||||||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | AlcoholOther3Spec | B1_a2.o3 | The Route by which the substance is used. Other alcohol text. | Text | Text | Character(50) | Must be completed if AlcoholOther3Days > 0, otherwise must be blank. | |
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsHeroinDays | B1_b1 | The number of days, in the past 30 days, that the client reports using a substance. Heroin. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsHeroinRoute B1_b1 The Route by which the substance is used. Heroin. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsMorphineDays | B1_b2 | The number of days, in the past 30 days, that the client reports using a substance. Morphine. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsMorphineRoute B1_b2 The Route by which the substance is used. Morphine. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsFentanylDays | B1_b3 | The number of days, in the past 30 days, that the client reports using a substance. Fetanyl (prescription diversion or illicit source). | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsFentanylRoute B1_b3 The Route by which the substance is used. Fetanyl (prescription diversion or illicit source). 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsDilaudidDays | B1_b4 | The number of days, in the past 30 days, that the client reports using a substance. Dilaudid. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsDilaudidRoute B1_b4 The Route by which the substance is used, Dilaudid. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsDemerolDays | B1_b5 | The number of days, in the past 30 days, that the client reports using a substance. Demoral. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsDemerolRoute B1_b5 The Route by which the substance is used. Demoral. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsPercocetDays | B1_b6 | The number of days, in the past 30 days, that the client reports using a substance. Percocet. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsPercocetRoute B1_b6 The Route by which the substance is used. Percocet. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsCodeineDays | B1_b7 | The number of days, in the past 30 days, that the client reports using a substance. Codeine. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsCodeineRoute B1_b7 The Route by which the substance is used. Codeine. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsTylenolDays | B1_b8 | The number of days, in the past 30 days, that the client reports using a substance. Tylenol 2, 3, 4. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsTylenolRoute B1_b8 The Route by which the substance is used. Tylenol 2, 3, 4. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsOxycoDays | B1_b9 | The number of days, in the past 30 days, that the client reports using a substance. OcyContin/Oxycodone. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsOxycoRoute B1_b9 The Route by which the substance is used. OcyContin/Oxycodone. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsNonPresMethadoneDays | B1_b10 | The number of days, in the past 30 days, that the client reports using a substance. Non-prescription methadone. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsNonPresMethadoneRoute B1_b10 The Route by which the substance is used. Non-prescription methadone. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsNonPresBupDays | B1_b11 | The number of days, in the past 30 days, that the client reports using a substance. Non-prescription buprenorphine. | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsNonPresBupRoute B1_b11 The Route by which the substance is used. Non-prescription buprenorphine. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | |||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsOther1Days | B1_b12.o1 | The number of days, in the past 30 days, that the client reports using a substance. Other opioids (specify). | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsOther1Route B1_b12.o1 The Route by which the substance is used. Other opioids (specify). 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | ||||||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsOther1Spec | B1_b12.o1 | The number of days, in the past 30 days, that the client reports using a substance. Other opioids (specify) text. | Text | Text | Character(50) | Must be completed if OpioidsOther1Days > 0, otherwise must be blank. | |
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsOther2Days | B1_b12.o2 | The number of days, in the past 30 days, that the client reports using a substance. Other opioids (specify). | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsOther2Route B1_b12.o2 The Route by which the substance is used. Other opioids (specify). 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. | ||||||||
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsOther2Spec | B1_b12.o2 | The number of days, in the past 30 days, that the client reports using a substance. Other opioids (specify) text. | Text | Text | Character(50) | Must be completed if OpioidsOther2Days > 0, otherwise must be blank. | |
| Yes | Yes | B. SUBSTANCE USE AND PLANNED SERVICES | OpioidsOther3Days | B1_b12.o3 | The number of days, in the past 30 days, that the client reports using a substance. Other opioids (specify). | 0 to 30 = days (90 day exception for some GFAs) |
-7 = Refused -9 = Missing Data 0 to 30 = days (90 day exception for some GFAs) -7 = Refused -9 = Missing Data Numeric If any Days field is -7 (Refused) or -9 (Missing Data) then all must be.
0 - 90 days applies at Intake only for ORP, DCT-AD, DCT-FA, and FTDC Program grants only Yes Yes B. SUBSTANCE USE AND PLANNED SERVICES OpioidsOther3Route B1_b12.o3 The Route by which the substance is used. Other opioids (specify). 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. 1 = Oral 2 = Intranasal 6 = Vaping 3 = Smoking 4 = Non-IV Injection 5 = IV Injection 0 = Other -1 = Not Applicable -7 = Refused -9 = Missing Data
| NOTE: THE NUMBERING OF THE RESPONSE OPTIONS DOES NOT CORRESPOND TO THE NUMBERS IN THE PAPER TOOL. | Numeric | Route field must be -1 (NA) if corresponding Days field is <= 0. |
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