ATTACHMENT 23 - Opiod NonCancer Pain Mgt Assmt Doc Templt_Concept Structure_2018-06-07.pdf

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R405--Clinical Decision Support CO: Matthew Klempay CS: Sharif Shabaz Ra-El
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36C77620R0015
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This is a pre-solicitation notice for a multiple-award IDIQ contract for clinical decision support (CDS) services. The Department of Veterans Affairs (VA) Program Contracting Activity Central will solicit proposals for ten-year IDIQ contracts with a fifteen-year effective period. The scope includes subject matter expertise, policy guidance, and strategic recommendations regarding CDS standards implementation for VA IT systems. The NAICS code is 541611 with a $16.5 million size standard. The solicitation will be a small business set-aside advertised on FEDBIZOPPS and the VA vendor portal for 28 days, with an estimated posting of August 11, 2018. All questions must be directed to the contracting officer and specialist listed.

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ATTACHMENT 6 - TMS User Request.doc DOC document
ATTACHMENT 29 - Opiod Non Cancer Pain Mgt Order Set_KNART XML_2018-06-25.pdf PDF
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ATTACHMENT 19 - Suicide Risk (Suicidality)_CDS Content White Paper_2019-01-02.pdf PDF
ATTACHMENT 25 - Opioid NonCancer Pain Mgt Order Set Conceptual Structure_2018-05-28.pdf PDF
ATTACHMENT 17 - SuicideRisk Assessment Doc Template KNART_Terminology Svc Request_V1.4_20180425.xlsx XLSX spreadsheet
ATTACHMENT C - Sample conceptual Structure for ECA Rule.docx DOCX document
ATTACHMENT 14 - Opiod Chronic Pain_OrderSet_ Terminology Svc Request_V1.1_20180524.xlsx XLSX spreadsheet
ATTACHMENT 24 - Opioid Non Cancer Pain Mgt_CDS Content White Paper_2018-12-18.pdf PDF
ATTACHMENT 16 - Opioid ChronicPain Doc Template_Terminology Svc Request_V1.2_20180607.xlsx XLSX spreadsheet
ATTACHMENT 28 - Suicide Risk Order Set KNART XML_2018-06-21.pdf PDF
ATTACHMENT B - Process for Requesting New Terminology Artifacts.docx DOCX document
ATTACHMENT 26 - Opiod Non Cancer Pain Assmt Doc Template KNART XML_2018-06-21.pdf PDF
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ATTACHMENT 22 - Mental Health Positive Suicide Risk Screening.pdf PDF
ATTACHMENT 8 - Contractor Staff Roster.doc DOC document
ATTACHMENT 21 - Mental Health Suicide Risk Assessment.pdf PDF
ATTACHMENT 20 - Suicide Risk_Order Set_KNART Conceptual Structure_2018-06-21.pdf PDF
ATTACHMENT 27 - Opiod Use Non Cancer Pain_OTTR-STORM Query_Doc Templt KNART XML_2018-06-21.pdf PDF
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ATTACHMENT 18 - Opioid NonCancer Pain OTRR-STORM Doc Templt_Concept Structure_2018-06-06.pdf PDF
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Mental Health: Chronic Noncancer Pain Documentation Template

Documentation Tem-plate: Conceptual Structure

Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007, CLIN0009DA

Department of Veterans Affairs (VA)

Knowledge Based Systems (KBS) Office of Informatics and Information Governance (OIIG)

Clinical Decision Support (CDS)

Publication date 06/07/2018

Version: 1.0

Mental Health: Chronic Noncancer Pain Documentation Template:

Documentation Template: Conceptual Structure by Knowledge Based Systems (KBS), Office of Informatics and Information Governance (OIIG), and Clinical Decision Support (CDS)

Publication date 06/07/2018 Copyright © 2018 B3 Group, Inc.

Copyright © 2018 Cognitive Medical Systems, Inc.

B3 Group, Inc.

NOTICE OF GOVERNMENT COPYRIGHT LICENSE AND UNLIMITED RIGHTS LICENSE

Licensed under the Apache License, Version 2.0 (the "License"); you may not use this file except in compliance with the License.

You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0

Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.

Portions of this content are derivative works from content produced by Cognitive Medical Systems, Inc. licensed under the Apache License, Version 2.0.

Additional portions of this content are derivative works from content contributed by Motive Medical Intelligence Inc., under Creative Commons Attribution-ShareAlike 4.0.

Contributions from 2013-2018 were performed either by US Government employees, or under US Veterans Health Administration contracts.

US Veterans Health Administration contributions by government employees are work of the U.S. Government and are not subject to copyright protection in the United States. Portions contributed by government employees are USGovWork (17USC §105). Not subject to copyright.

See: https://www.usa.gov/government-works

Contribution by contractors to the US Veterans Health Administration during this period are contractually contributed under the Apache License, Version 2.0 and US Government sponsorship is acknowledged under Contract VA118-16-D-1008, Task Order VA11817F10080007.

Cognitive Medical Systems, Inc.

Licensed under the Apache License, Version 2.0 (the "License"); you may not use this file except in compliance with the License.

You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0

Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.

This and related content produced by Cognitive Medical Systems, Inc. licensed under the Apache License, Version 2.0 is available at: https:// bitbucket.org/cogmedsys/hl7-kas-examples

Additional portions of this content are derivative works from content contributed by Motive Medical Intelligence Inc., under Creative Commons Attribution-ShareAlike 4.0. https://bitbucket.org/cogmedsys/kas-source-material

Contributions from 2013-2018 were performed either by US Government employees, or under US Veterans Health Administration contracts.

US Veterans Health Administration contributions by government employees are work of the U.S. Government and are not subject to copyright protection in the United States. Portions contributed by government employees are USGovWork (17USC §105). Not subject to copyright. See:

https://www.usa.gov/government-works

Contribution by contractors to the US Veterans Health Administration during this period are contractually contributed under the Apache License, Version 2.0 and US Government sponsorship is acknowledged under Contract VA118-16-D-1008-0007.

http://www.apache.org/licenses/LICENSE-2.0 https://www.usa.gov/government-works http://www.apache.org/licenses/LICENSE-2.0 https://bitbucket.org/cogmedsys/hl7-kas-examples https://bitbucket.org/cogmedsys/hl7-kas-examples https://bitbucket.org/cogmedsys/kas-source-material https://www.usa.gov/government-works

Table of Contents Preface .............................................................................................................................. v Artifact Applicability ......................................................................................................... vii Models ........................................................................................................................... viii

1. External Data Definitions

Definitions Triggers

2. Expression Definitions

3. Visit Information

4. Physical Exam

5. Pain Description

6. Relevant Vitals

7. Relevant Laboratory Values

8. Medication Profile

9. Nonpharmacologic treatment

10. Patient Education

11. Activities of Daily Living

12. Affect/Mood

13. Risk Mitigation Strategies

14. Assessment

15. Plan

16. Tabular List

17. Behavior Symbols A. References iii

List of Tables

1. Revision History ............................................................................................................. v

2. Clinical White Paper Contributors ...................................................................................... v

3. Artifact Identifier ........................................................................................................... vi

4. Applicability Foci, Description and Codes ......................................................................... vii

5. Model References ......................................................................................................... viii

1.1. Pertinent Surgical History

1.2. Medications

1.3. Current Medications

1.4. Complete Blood Count

1.5. Comprehensive Metabolic Panel

1.6. Hemoglobin A1c

1.7. Toxicology Screen

1.8. 25-hydroxyvitamin D

1.9. Pain diagnoses

16.1. Terminology Versions

16.2. Terminology References

17.1. Group Organizational Behavior

17.2. Group Selection Behavior

17.3. Required Behavior

17.4. Precheck Behavior

17.5. Cardinality Behavior

17.6. Item Flags

17.7. Read Only Behavior

iv

Preface Table 1. Revision History

Date Life Cycle Event June 7, 2018 Published June 7, 2018 Reviewed March 1, 2018 Pre-published August 10, 2017 Created

Table 2. Clinical White Paper Contributors

Name Role Affiliation

Ilene Robeck, Physician

Author Physician, Richmond VA Medical Center (VAMC), Rich-mond, VA

Jodie Trafton, Di-rector

Author Director, VA Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park, CA

Friedhelm Sand-brink, Acting Di-rector of Pain Man-agement Program Office

Author Acting Director of Pain Management Program Office, De-partment of VA, Washington, DC

Elizabeth Oliva, OEND Coordinator

Author VA National Opioid Overdose Education and Naloxone Dis-tribution (OEND) Coordinator, VA Palo Alto Health Care System, Menlo Park, CA

Eleanor Lewis, Research Health Science Specialist

Author Research Health Science Specialist, VA Palo Alto Health Care System, Menlo Park, CA

Kendall Browne, Clinical Psycholo-gist

Author Clinical Psychologist, Seattle Puget Sound Health Care Sys-tem, Seattle, WA

Alicia Heapy, Men-tal Health

Author Mental Health, VA New England Healthcare System, West Haven, CT

Karen Drexler, National Mental Health Program Di-rector

Author National Mental Health Program Director, Substance Use Disorders, VA Central Office, Atlanta, GA

Andrew Saxon, Physician

Author Physician, Seattle Health Care System, Seattle, WA

Melissa Christo-pher, National Di-rector

Author National Director, Academic Detailing VACO Pharmacy Benefits Management (PBM), Mission Valley Annex VISN 22, San Diego, CA

Daina Wells Author United States

Lucille Burgo, Firm Chief, Prima-ry Care

Author Firm Chief, Primary Care, VA New England Healthcare Sys-tem, West Haven, CT v

Preface

Name Role Affiliation

Julianne Himstreet, Pharmacist

Author Pharmacist, Eugene, OR

Table 3. Artifact Identifier

Domain Artifact ID Name urn:va.gov:kbs:knart:artifact:r1 32771ec0-ec22-5209-8b74-0d2a862a9c2f O34 vi

Artifact Applicability Table 4. Applicability Foci, Description and Codes

Focus Description Code Sys-tem

Code Value Set Value Set Version

TargetUser Primary Care Provider (PCP)

SNOMED

CT

453231000124104 |Primary care provider (occupa-tion)|

N/A N/A

PatientAgeGroup Adult SNOMED

CT

133936004 |Adult (person)|

N/A N/A

ClinicalVenue Primary Care SNOMED

CT

5351000124100 | Primary care clinic (environment)|

N/A N/A

ClinicalVenue Outpatient SNOMED

CT

33022008 |Hospi-tal-based outpatient department (envi-ronment)|

N/A N/A vii

Models Table 5. Model References

Referenced Model Description urn:solor.io:anf-model:1.0 VA Analysis Normal Form Model viii

Chapter 1. External Data Definitions Definitions

Table 1.1. Pertinent Surgical History

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]: [TSR- NoCode]

Table 1.2. Medications

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]: [TSR- NoCode]

Table 1.3. Current Medications

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]: [TSR- NoCode]

Table 1.4. Complete Blood Count

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]:

[26604007 |Complete blood count (procedure)|]

Table 1.5. Comprehensive Metabolic Panel

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]:

[1411000205104 |Comprehensive metabolic panel (procedure)|]

Table 1.6. Hemoglobin A1c

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]:

[43396009 |Hemoglobin A1c measurement (procedure)|]

Table 1.7. Toxicology Screen

Expression: type=elm:SingletonFrom

External Data Definitions

Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]:

[314076009 |Toxicology screening test (procedure)|]

Table 1.8. 25-hydroxyvitamin D

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]:

[447678008 |Measurement of 25-hydroxyergocalciferol (procedure)|]

Table 1.9. Pain diagnoses

Expression: type=elm:SingletonFrom Annotation:

Codes: elm:value[elm:Code]: [398166005 |Performed (qualifier value)|]elm:value[elm:Code]: [TSR- NoCode]

Triggers

No trigger definitions are present.

Chapter 2. Expression Definitions No expression definitions are present.

Chapter 3. Visit Information prompt:

Telehealth encounter; patient gave verbal consent for telehealth re-sponse:

Boolean (Single) prompt:

Patient Name re-sponse:

String (Single) prompt:

Patient Age re-sponse:

Integer (Single) prompt:

Patient Race re-sponse:

Code (Single) prompt:

Patient Gender re-sponse:

Code (Single) prompt:

Subjective and objective description of patient's current active medical problems re-sponse:

String (Single)

☐ prompt: Initial Visit response: EntityName (Single) ☐ prompt: Follow-up Visit response: EntityName (Single) responseBinding: Property ("FollowUpVisitForProblems") Condition:elm:Property

☐ prompt: If follow-up visit, describe focus response: String (Single)

☐ prompt: Pertinent Surgical History response: Tuple (Single) initalValue: Pertinent Surgical History

☐ prompt: Medications response: Code (Single)

Visit Information initalValue: Medications

Chapter 4. Physical Exam ❂ prompt: Relevant findings on current physical exam

Chapter 5. Pain Description Impact of pain on function prompt:

Functional impact of pain re-sponse:

String (Single) prompt:

Functional impact of treatment for pain (positive or negative impact) re-sponse:

String (Single)

Type of pain prompt:

Neuropathic pain item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[247398009 |Neuropathic pain (finding)] re-sponse:

Boolean (Single) prompt:

Somatic pain item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[48429009 |Somatic pain (finding)] re-sponse:

Boolean (Single) prompt:

Other type of pain (describe details) re-sponse:

String (Single)

Pain location prompt:

Back item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[161891005 |Backache (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("BackPain") Condition:elm:Property Location of pain: Select all that apply (at least one) prompt:

Lower item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[279039007 |Low back pain (finding)] re-sponse:

Boolean (Single)

Pain Description prompt:

Middle item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[279038004 |Thoracic back pain (finding)] re-sponse:

Boolean (Single) prompt:

Upper item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 |Has focus (attribute))->[161896000 |Complaining of upper back ache (finding)] re-sponse:

Boolean (Single) prompt:

Neck item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[81680005 |Neck pain (finding)] re-sponse:

Boolean (Single) prompt:

Joints item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[57676002 |Joint pain (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("JointPain") Condition:elm:Property Location of pain: Select all that apply (at least one) prompt:

Knee item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[30989003 |Knee pain (finding)] re-sponse:

Boolean (Single) prompt:

Hip item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[49218002 |Hip pain (finding)] re-sponse:

Boolean (Single) prompt:

Shoulder item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[45326000 |Shoulder pain (finding)] re-sponse:

Boolean (Single) prompt:

Other (describe details) re-sponse:

String (Single) prompt:

Abdominal item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[21522001 |Abdominal pain (finding)] re-sponse:

Boolean (Single) prompt:

Other location of pain (describe details) re-sponse:

String (Single)

Aggrevating factors prompt:

Cold weather item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[200c9d89-dee9-4f0e-903f-53f77fbf5bd6 |Pain aggra-vated by cold weather (finding)] re-sponse:

Boolean (Single) prompt:

Climate change item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[e583ef45-eddb-4028-bb7b-73171c6734b9 |Pain ag-gravated by change in climate (finding)] re-sponse:

Boolean (Single) prompt:

Diabetes item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[88004a00-3b67-408b-8737-fe0cce58ddcf |Pain ag-gravated by diabetes (finding)] re-sponse:

Boolean (Single) prompt:

Hormone imbalance item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[6be254c4-4309-4d3c-8a79-53d9bd184bcb |Pain ag-gravated by hormone imbalance (finding)] re-sponse:

prompt:

Infectious disease item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[972638ea-cc75-48f2-a881-16358a798848 |Pain ag-gravated by infectious disease (finding)] re-sponse:

Boolean (Single) prompt:

Inflammatory process item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[d57ab696-0ec2-479a-be85-9fb7ee17655f |Pain ag-gravated by inflammatory process (finding)] re-sponse:

Boolean (Single) prompt:

Mental health–related problems item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[d415a2fc-d8ff-47a2-949b-37193db38df4 |Pain ag-gravated by mental health problems (finding)] re-prompt:

Anxiety item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[2957a442-7e93-4eeb-9527-c7042c2cba0f | Pain aggravated by anxiety (finding)] re-sponse:

Boolean (Single) prompt:

Depression item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[6ae3b455-5b3d-44b4-aa25-b9ed03dea815 | Pain aggravated by depression (finding)] re-sponse:

Boolean (Single) prompt:

Military sexual trauma item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[bf8ceb54-0a74-46f1-a43e-646b3587d564 | Pain aggravated by sexual trauma during military service (finding)] re-sponse:

Boolean (Single) prompt:

Postraumatic Stress Disorder item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[34c30e9b-a621-44ad-8d13-6806f4c7a7f3 | Pain aggravated by post-traumatic stress disorder (finding)] re-sponse:

Boolean (Single) prompt:

Other mental health problems (describe details) re-sponse:

String (Single) prompt:

Movement item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[6833f7dd-cd16-4987-8320-db07729a89df |Pain ag-gravated by movement (finding)] re-sponse:

Boolean (Single) prompt:

Poor nutrition item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[061d5677-0600-4b60-98b0-e4a0c5fd3a84 |Pain ag-gravated by poor nutrition (finding)] re-sponse:

Boolean (Single) prompt:

Poor sleep item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[594d0a01-ed45-4021-86dc-4b3c1f826113 |Pain ag-gravated by poor sleep (finding)] re-sponse:

Boolean (Single) prompt:

Prolonged sitting item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[ec406ab7-1200-4ef4-b31e-062896495a4a |Pain ag-gravated by prolonged sitting (finding)] re-sponse:

Boolean (Single) prompt:

Prolonged standing item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[d1bdabcd-d0e8-45da-b4ad-d9159049d824 |Pain ag-gravated by prolonged standing (finding)] re-sponse:

Boolean (Single) prompt:

Risky behaviors related to opioid use

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[427346002 |Risk prone health behavior (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("Opoid") Condition:elm:Property prompt:

Concurrent use of other substances that increase risk (e.g., alcohol, cannabis) item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[228372006 |Poly-drug misuser (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("ConcurrentUse") Condition:elm:Property prompt:

Details re-sponse:

String (Single) prompt:

Early refills item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[1a0ef3fa-4e70-4a84-bedf-706396899f63 | Obtains early refills of opioid prescriptions (finding)] re-sponse:

Boolean (Single) prompt:

Multiple prescribers item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[6d75b166-20b5-4fe5-98a0-d38ec561d5fa | Uses multiple prescribers (finding)] re-sponse:

Boolean (Single) prompt:

Use of opioids for sleep item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[b71c0528-33ce-499b-aef8-b095f8c2900e | Uses opioids to support sleep (finding)] re-sponse:

Boolean (Single) prompt:

Use of opioids for stress item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[e5530930-acc3-4778-943d-a7def9476607 | Uses opioids for stress relief (finding)] re-sponse:

prompt:

Use of opioids in a manner other than prescribed re-sponse:

Boolean (Single) responseBinding: Property ("UseOfOpoids") Condition:elm:Property prompt:

Detail re-sponse:

String (Single) prompt:

Use of opioids not prescribed to patient re-sponse:

Boolean (Single) responseBinding: Property ("NotPrescribed") Condition:elm:Property prompt:

Detail re-sponse:

String (Single) prompt:

Other re-sponse:

String (Single) prompt:

Stress item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[73595000 |Stress (finding)] re-sponse:

Boolean (Single) prompt:

Structural imbalance item- Code:

TSR-NoCode re-sponse:

Boolean (Single) prompt:

Substance use (current or former) re-sponse:

Boolean (Single) prompt:

Alcohol

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[219006 |Current drinker of alcohol (find-ing)] item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[82581004 |Ex-drinker (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("AlcoholUse") Condition:elm:Property prompt:

Current user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[219006 |Current drinker of alcohol (finding)] re-

Amount and frequency of use re-sponse:

String (Single) prompt:

Former user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[82581004 |Ex-drinker (finding)] re-

Quit date (if date unknown, indicate year) re-sponse:

Timestamp (Single) prompt:

Additional details re-sponse:

String (Single) prompt:

Cannabis re-sponse:

Boolean (Single) responseBinding: Property ("CannabisUse") Condition:elm:Property❂ prompt:

Legal recreational

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[36358673-9d77-4c7a-987b-441f8f5da653 |User of legal recreational marijuana (finding)] item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 |Has focus (attribute))->[7804d280-befe-4ba7-9387-86019285144f |Ex-user of legal recreational marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("LegalRecreation") Condition:elm:Property prompt:

Current user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[36358673-9d77-4c7a-987b-441f8f5da653 |User of legal recreational marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("CurrentLegalUser") Condition:elm:Property prompt:

Amount and frequency of use re-sponse:

String (Single) prompt:

Former user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[7804d280-befe-4ba7-9387-86019285144f |Ex-user of legal recreational marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("FormerLegalUser") Condition:elm:Property prompt:

Quit date (if date unknown, indicate year) re-sponse:

Timestamp (Single) prompt:

Additional details re-sponse:

String (Single) prompt:

Illicit recreational

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[31760619-c4c2-4d6c-aa46-4a2d8e7733cd |User of illicit recreational marijuana (finding)] item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[7516f2f5-8171-4d6d-af28-fbb0994b6b4c |Ex-user of illicit recreational marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("IllicitRecreational") Condition:elm:Property prompt:

Current user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[31760619-c4c2-4d6c-aa46-4a2d8e7733cd |User of illicit recreational marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("CurrentIllicitUser") Condition:elm:Property prompt:

Amount and frequency of use re-sponse:

String (Single) prompt:

Former user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[7516f2f5-8171-4d6d-af28-fbb0994b6b4c |Ex-user of illicit recreational marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("FormerIllicitUser") Condition:elm:Property prompt:

Quit date (if date unknown, indicate year) re-sponse:

Timestamp (Single) prompt:

Additional details re-sponse:

String (Single) prompt:

Medical

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[ac23a526-dc71-4264-b359-61f2b5ab7a1b |User of medical marijuana (finding)] item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[6eec41c4-15b3-4d7c-b731-d7b126690f47 |Ex-user of medical marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("MedicalUse") Condition:elm:Property prompt:

Current user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[ac23a526-dc71-4264-b359-61f2b5ab7a1b |User of medical marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("CurrentMedicalUser") Condition:elm:Property prompt:

Amount and frequency of use re-sponse:

String (Single) prompt:

Former user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[6eec41c4-15b3-4d7c-b731-d7b126690f47 |Ex-user of medical marijuana (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("FormerMedicalUser") Condition:elm:Property prompt:

Quit date (if date unknown, indicate year) re-sponse:

Timestamp (Single) prompt:

Additional details re-sponse:

String (Single) prompt:

Illicit drugs item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[307052004 |Illicit drug use (finding)]

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[b1c03656-6306-47d6-8ee6-a80227b99e4a |Ex-user of illicit drugs (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("IllicitDrugs") Condition:elm:Property prompt:

Drug re-sponse:

String (Single) responseBinding: Property ("DrugUser") Condition:elm:Property prompt:

Current user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[307052004 |Illicit drug use (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("CurrentDrugUser") Condition:elm:Property prompt:

Amount and frequency of use re-sponse:

String (Single) prompt:

Former user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observa-tion procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[b1c03656-6306-47d6-8ee6-a80227b99e4a |Ex-user of illicit drugs (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("FormerDrugUser") Condition:elm:Property prompt:

Quit date (if date unknown, indicate year) re-sponse:

Timestamp (Single) prompt:

Additional details re-sponse:

prompt:

Tobacco item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[110483000 |Tobacco user (finding)] item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[702975009 |Ex-tobacco user (finding)] re-sponse:

Boolean (Single) responseBinding: Property ("TobaccoUser") Condition:elm:Property prompt:

Current user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[110483000 |Tobacco user (finding)] re-sponse:

Boolean (Single) re-sponse range:

EnumerationConstraint (List) item: Every day item: Some days item: Not at all prompt:

Amount of frequency or use re-sponse:

String (Single) prompt:

Former user item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (pro-cedure)] ->(363702006 |Has focus (attribute))->[702975009 |Ex-tobacco user (finding)] re-sponse:

Boolean (Single) prompt:

Quit date (if date unknown, indicate year) re-sponse:

Timestamp (Single) prompt:

Additional details re-sponse:

String (Single) prompt:

Toxic Exposure

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[75478009 |Poisoning (disorder)] re-sponse:

Boolean (Single) prompt:

Other re-sponse:

Boolean (Single) responseBinding: Property ("Other") Condition:elm:Property prompt:

Details re-sponse:

String (Single)

Alleviating factors prompt:

Lying down item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[172f1507-d6f0-4c48-bd1e-95dd477754d6 |Pain re-lief by lying down (finding)] re-sponse:

Boolean (Single) prompt:

Rest item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[427935006 |Pain relief by rest (finding)] re-sponse:

Boolean (Single) prompt:

Heat item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[79ede33a-45a2-46f9-a3be-94bb384e747a |Pain relief by application of heat (finding)] re-sponse:

Boolean (Single) prompt:

Ice item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[3c4d6355-2e1d-4a9a-b8e7-0bc90204209a |Pain re-lief by application of ice (finding)] re-sponse:

Boolean (Single) prompt:

Limb elevation

Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[e49cc42c-afa0-4f52-9b1b-6509d31b68bc |Pain relief by elevation of limb (finding)] re-sponse:

Boolean (Single) prompt:

Movement item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[ad5e2961-02f1-40dd-aafb-82821f6ac985 |Pain relief by movement (finding)] re-sponse:

Boolean (Single) prompt:

Complementary integrative health (e.g., mindfulness) item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[796908f2-6b92-435f-a098-c648fdb36029 |Pain relief by integrative health therapy (finding)] re-sponse:

Boolean (Single) prompt:

Cognitive behavioral approaches (e.g., meeting with friends, music) item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] - >(363702006 |Has focus (attribute))->[3e7f9703-bd6a-42da-b727-be43f988876e |Pain relief by cognitive behavioral approach (finding)] re-sponse:

Boolean (Single) prompt:

Other (provdide details re-sponse:

Chapter 6. Relevant Vitals ☐ prompt: Body Mass Index itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] -

>(363702006 |Has focus (attribute))->[301331008 |Finding of body mass index (finding)] response: Real (Single) ☐ prompt: Blood Pressure itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] -

>(363702006 |Has focus (attribute))->[163020007 |On examination - blood pressure reading (finding)] response: Integer (Single) ☐ prompt: Respiratory Rate itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] -

>(363702006 |Has focus (attribute))->[301283003 |Finding of rate of respiration (finding)] response: Integer (Single) ☐ prompt: Heart Rate itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] -

>(363702006 |Has focus (attribute))->[301113001 |Finding of heart rate (finding)] response: Integer (Single) ☐ prompt: Other relevant vitals

Chapter 7. Relevant Laboratory Values ☐ prompt: Complete Blood Count response: Tuple (Single) initalValue: Complete Blood Count ☐ prompt: Comprehensive Metabolic Panel response: Tuple (Single) initalValue: Comprehensive Metabolic Panel ☐ prompt: Hemoglobin A1c response: Tuple (Single) initalValue: Hemoglobin A1c ☐ prompt: Toxicology Screen response: Tuple (Single) initalValue: Toxicology Screen ☐ prompt: 25-hydroxyvitamin D response: Tuple (Single) initalValue: 25-hydroxyvitamin D ☐ prompt: Other detail

Chapter 8. Medication Profile prompt:

Allergies item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[609328004 |Allergic disposition (disorder)] re-sponse:

String (Single) prompt:

Adverse drug reactions item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[62014003 |Adverse reaction caused by drug (disorder)] re-sponse:

String (Single) prompt:

History of overdose and opioid-related emergency department visits and hospital admissions item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]- ->(363702006 | Has focus (attribute))->[185265000 |Seen in emergency clinic (finding)]- ->(42752001 |Due to (at-tribute))->[5602001 |Opioid abuse (disorder)] item- Code:

[32485007 |Hospital admission (procedure)] ->(363702006 |Has focus (attribute))->[5602001 |Opi-oid abuse (disorder)] re-sponse:

Boolean (Single) responseBinding: Property ("Overdoses") Condition:elm:Property

☐ prompt: Prior overdose itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] -

>(363702006 |Has focus (attribute))->[242253008 |Overdose of opiate (disorder)] response: Boolean (Single) responseBinding: Property ("PriorOverdose") Condition:elm:Property

☐ prompt: Date(s) response: Timestamp (Single) ☐ prompt: Drug(s) response: Code (Single) ☐ prompt: Additional details response: String (Single) ☐ prompt: Prior opioid-related emergency department visit(s) itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]- -

>(363702006 |Has focus (attribute))->[185265000 |Seen in emergency clinic (find-ing)]- ->(42752001 |Due to (attribute))->[5602001 |Opioid abuse (disorder)] response: Boolean (Single) responseBinding: Property ("PriorEmergencyVisit")

Medication Profile

Condition:elm:Property

☐ prompt: Date(s) response: Timestamp (Single) ☐ prompt: Drug(s) response: Code (Single) ☐ prompt: Additional details response: String (Single) ☐ prompt: Prior opioid-related hospital admission(s) itemCode: [32485007 |Hospital admission (procedure)] ->(363702006 |Has focus (at-tribute))->[5602001 |Opioid abuse (disorder)] response: Boolean (Single) responseBinding: Property ("PriorHospital") Condition:elm:Property

☐ prompt: Date(s) response: Timestamp (Single) ☐ prompt: Drug response: Code (Single) ☐ prompt: Additional details response: String (Single) prompt:

Current Medications re-sponse:

Code (Single) initalValue: Current Medications prompt:

Non-VA medications re-sponse:

Code (Single) prompt:

Previous pain-related medications re-sponse:

Code (Single)

Chapter 9. Nonpharmacologic treatment

Nonpharmacologic treatment/complementary integrative health prompt:

Physical Therapy item- Code:

91251008 |Physical therapy procedure (regime/therapy)| re-sponse:

Boolean (Single) responseBinding: Property ("Physical Therapy") Condition:elm:Property

☐ prompt: Dates response: Timestamp (Single) ☐ prompt: Detail response: String (Single) prompt:

Whole health interventions re-sponse:

Boolean (Single) responseBinding: Property ("WholeHealth") Condition:elm:Property

☐ prompt: Dates response: Timestamp (Single) ☐ prompt: Detail

☐ prompt: Acupuncture itemCode: 44868003 |Acupuncture (procedure)| response: Boolean (Single) ☐ prompt: Tai Chi itemCode: 229223006 |Participation in Tai Chi (regime/therapy)| response: Boolean (Single) ☐ prompt: Yoga itemCode: 229224000 |Participation in yoga (regime/therapy)| response: Boolean (Single) ☐ prompt: Mindfulness itemCode: 05257e84-e247-4f2e-bb83-dccd395d56a8 |Mindfulness therapy

(procedure)| response: Boolean (Single)

Nonpharmacologic treatment

☐ prompt: Meditation itemCode: 386365008 |Meditation facilitation (procedure)| response: Boolean (Single) ☐ prompt: Guided imagery itemCode: 228565006 |Imagery technique (regime/therapy)| response: Boolean (Single) ☐ prompt: Hypnotherapy itemCode: 19997007 |Hypnotherapy (regime/therapy)| response: Boolean (Single) ☐ prompt: Biofeedback itemCode: 28150003 |Biofeedback procedure (regime/therapy)| response: Boolean (Single) prompt:

Other non-pharmacoligic treatment re-sponse:

Boolean (Single) responseBinding: Property ("OtherNonPharamcologic") Condition:elm:Property prompt:

Details re-sponse:

Chapter 10. Patient Education prompt:

Disease-state education re-sponse:

Boolean (Single) responseBinding: Property ("DiseaseState") Condition:elm:Property

☐ prompt: Dates response: Timestamp (Single) ☐ prompt: Detail response: String (Single) ☐ prompt: Other response: Boolean (Single) ☐ prompt: Detail response: String (Single) prompt:

Lifestyle counseling and education re-sponse:

Boolean (Single) responseBinding: Property ("Lifestyle") Condition:elm:Property

☐ prompt: Dates response: Timestamp (Single) ☐ prompt: Details response: String (Single) prompt:

Other re-sponse:

responseBinding: Property ("OtherEducation")

☐ prompt: Details

Chapter 11. Activities of Daily Living Energy level

○ prompt: Low itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]-

->(363702006 |Has focus (attribute))->[301325005 |Finding of general energy (finding)]- ->(363714003 |Interprets (attribute))->[359755007 |Energy / stamina (observable entity)]- (363713009 |Has interpretation (attribute))->[62482003 |Low (qualifier value)] response: Boolean (Single)

○ prompt: Medium itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]-

->(363702006 |Has focus (attribute))->[301325005 |Finding of general energy (finding)]- ->(363714003 |Interprets (attribute))->[359755007 |Energy / stami-na (observable entity)]- (363713009 |Has interpretation (attribute))->[1fb50fd0-c49f-4a2b-b4e1-df6699a4cc10 |Medium (qualifier value)] response: Boolean (Single)

○ prompt: High itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]-

->(363702006 |Has focus (attribute))->[301325005 |Finding of general energy (finding)]- ->(363714003 |Interprets (attribute))->[359755007 |Energy / stamina (observable entity)]- (363713009 |Has interpretation (attribute))->[75540009 |High (qualifier value)] response: Boolean (Single) prompt:

Average number of hours of sleep per night item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[118190003 |Sleep finding (finding)] re-sponse:

Real (Single)

Early Awakening

○ prompt: Early Awakening itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] -

>(363702006 |Has focus (attribute))->[67062000 |Terminal insomnia (disorder)] response: Boolean (Single)

Cause of early awakening

☐ prompt: Pain itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]- ->(363702006 |Has focus (at-tribute))->[67062000 |Terminal insomnia (disorder)]- - >(42752001 |Due to (attribute))->[22253000 |Pain (finding)];

response: Boolean (Single) ☐ prompt: Nightmares itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]- ->(363702006 |Has focus (at-

Activities of Daily Living tribute))->[67062000 |Terminal insomnia (disorder)]- - >(42752001 |Due to (attribute))->[419145002 |Nightmares (find-ing)];

response: Boolean (Single) ☐ prompt: Restless leg syndrome itemCode: [a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)]- ->(363702006 |Has focus (at-tribute))->[67062000 |Terminal insomnia (disorder)]- - >(42752001 |Due to (attribute))->[32914008 |Restless legs (disor-der)];

response: Boolean (Single) ☐ prompt: Other (provide details) response: String (Single) prompt:

Uses continuous positive airway pressure (CPAP)?

item- Code:

47545007 |Continuous positive airway pressure ventilation treatment (regime/therapy)| re-

○ prompt: Changes in level of functioning since previous visit?

responseBinding: Property ("ChangesInFunctioning") Condition:elm:Property

○ prompt: Provide details response: String (Single) prompt:

Other activities of daily living information re-sponse:

Chapter 12. Affect/Mood prompt:

Anxiety item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[197480006 |Anxiety disorder (disorder)] re-sponse:

Boolean (Single) prompt:

Depression item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[35489007 |Depressive disorder (disorder)] re-sponse:

Boolean (Single) prompt:

Thoughts of suicidality item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[6471006 |Suicidal thoughts (finding)] re-sponse:

Boolean (Single) prompt:

Thoughts of homicidality item- Code:

[a997cc03-3e99-40eb-833a-6374c7750a3a |Observation procedure (procedure)] ->(363702006 | Has focus (attribute))->[225450009 |Homicidal thoughts (finding)] re-sponse:

Boolean (Single) prompt:

Other re-sponse:

responseBinding: Property ("OtherThoughts")

Chapter 13. Risk Mitigation Strategies prompt:

Informed consent for opioid therapy item- Code:

[182771004 |Informed consent for procedure (procedure)] ->(363702006 |Has focus (at-tribute))->[726582005 |Opiate therapy (procedure)] re-sponse:

Boolean (Single) prompt:

Toxicology Screen item- Code:

314076009 |Toxicology screening test (procedure)| re-

☐ prompt: Expected

☐ prompt: Unexpected response: Boolean (Single) ☐ prompt: Not done; needs to be ordered response: Boolean (Single) ☐ prompt: Presence of alcohol response: Boolean (Single) ☐ prompt: Absence of prescribed medication response: Boolean (Single) ☐ prompt: Further follow-up needed response: Boolean (Single) ☐ prompt: No further follow-up needed at this time response: Boolean (Single) prompt:

Query of the State Prescription Drug Monitoring Program (PDMP) re-sponse:

Boolean (Single) responseBinding: Property ("PDMP") Condition:elm:Property

☐ prompt: Detail response: String (Single) prompt:

Overdose education provided, and naloxone distributed re-sponse:

Boolean (Single) prompt:

Pill counts

Risk Mitigation Strategies re-sponse:

responseBinding: Property ("PillCounts")

Chapter 14. Assessment prompt:

Pain diagnoses item- Code:

TSR-NoCode re-sponse:

Code (Single) responseBinding: Property ("PainDiagnoses") initalValue: Pain diagnoses

Chapter 15. Plan Interventions in this section are presented in order of recommended sequence in the VA prompt:

Goals of therapy (established by patient) re-sponse:

String (Single) prompt:

Self-care re-

☐ prompt: Movement and stretching itemCode: 229064008 |Movement therapy (regime/therapy)| itemCode: 229070002 |Stretching exercises (regime/therapy)| response: Boolean (Single) responseBinding: Property ("Movement") Condition:elm:Property

☐ prompt: Detail response: String (Single) ☐ prompt: Nutrition itemCode: 386373004 |Nutrition therapy (regime/therapy)| response: Boolean (Single) responseBinding: Property ("Nutrition") Condition:elm:Property

☐ prompt: Detail

☐ prompt: Sleep and rest itemCode: 225206006 |Sleep and rest interventions (procedure)| response: Boolean (Single) responseBinding: Property ("Sleep") Condition:elm:Property

☐ prompt: Detail

☐ prompt: Stress resilience itemCode: 226060000 |Stress management (procedure)| response: Boolean (Single) responseBinding: Property ("Stress")

Plan

☐ prompt: Social connection itemCode: 38256005 |Social network therapy (regime/therapy)| response: Boolean (Single) responseBinding: Property ("Social") Condition:elm:Property

☐ prompt: Detail response: String (Single) prompt:

Non-pharmacoloigic interventions re-

☐ prompt: Physical therapy itemCode: 91251008 |Physical therapy procedure (regime/therapy)| response: Boolean (Single) ☐ prompt: Whole health interventions response: Boolean (Single) responseBinding: Property ("WholeHealthInterventions") Condition:elm:Property

☐ prompt: Acupunctuve itemCode: 44868003 |Acupuncture (procedure)| response: Boolean (Single) ☐ prompt: Tai Chi itemCode: 229223006 |Participation in Tai Chi (regime/therapy)| response: Boolean (Single) ☐ prompt: Yoga itemCode: 229224000 |Participation in yoga (regime/therapy)| response: Boolean (Single) ☐ prompt: Mindfulness itemCode: 05257e84-e247-4f2e-bb83-dccd395d56a8 |Mindfulness therapy

(procedure)| response: Boolean (Single) ☐ prompt: Meditation itemCode: 386365008 |Meditation facilitation (procedure)| response: Boolean (Single) ☐ prompt: Guided imagery itemCode: 228565006 |Imagery technique (regime/therapy)|

☐ prompt: Hypnotherapy itemCode: 19997007 |Hypnotherapy (regime/therapy)| response: Boolean (Single) ☐ prompt: Biofeedback itemCode: 28150003 |Biofeedback procedure (regime/therapy)| response: Boolean (Single)

☐ prompt: Disease-state education itemCode: 84635008 |Disease process or condition education (procedure)| response: Boolean (Single) ☐ prompt: Lifestyle counseling and education itemCode: 715756009 |Lifestyle adjustment training (procedure)| response: Boolean (Single) ☐ prompt: Psychotherapy itemCode: 75516001 |Psychotherapy (regime/therapy)| response: Boolean (Single) ☐ prompt: Cognitive behavioral therapy itemCode: 304891004 |Cognitive - behavior therapy (regime/therapy)| response: Boolean (Single) ☐ prompt: Acceptance and commitment therapy itemCode: aada5366-f841-4015-9c6a-5dd1a22a8ee3 |Acceptance and commitment therapy

(regime/therapy)| response: Boolean (Single) ☐ prompt: Substance use disorder interventions itemCode: 424407005 |Substance use cessation education, guidance, and counseling (proce-dure)| response: Boolean (Single) ☐ prompt: Tobacco cessation interventions itemCode: 702388001 |Tobacco use cessation education (procedure)| response: Boolean (Single) ☐ prompt: Other response: Boolean (Single) responseBinding: Property ("OtherDiseaseState") Condition:elm:Property

☐ prompt: Detail response: String (Single) prompt:

Follow-up on toxicology screen re-sponse:

Boolean (Single) responseBinding: Property ("FollowUpToxicology")

☐ prompt: Detail response: String (Single) prompt:

Medication interventions re-

❂ prompt: Non-opioid pain medication itemCode: [416118004 |Administration (procedure)] ->(260686004 |Method (at-tribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[322208004 |Non-opioid analgesics (product)] response: Boolean (Single) ❂ prompt: Opioid pain medication itemCode: [416118004 |Administration (procedure)] ->(260686004 |Method (at-tribute))->[129445006 |Administration - action (qualifier value)] ->(363701004 | Direct substance (attribute))->[404642006 |Substance with opioid receptor agonist mechanism of action (substance)] response: Boolean (Single) responseBinding: Property ("Opoid")

Condition:elm:Property

❂ prompt: Query State PDMP response: Boolean (Single) ❂ prompt: Sign or Initiate consent for opioid therapy response: Boolean (Single) ❂ prompt: Management/prevention of opioid-induced constipation itemCode: [169443000 |Preventive procedure (procedure)]- ->(363702006

|Has focus (attribute))->[14760008 |Constipation (disorder)]- - >(246075003 |Causative agent (attribute))->[404642006 |Sub-stance with opioid receptor agonist mechanism of action (sub-stance)];

response: Boolean (Single) ❂ prompt: Overdose education and naloxone distribution itemCode: 718021000 |Education about take home naloxone for opiate over-dose intervention (procedure)| response: Boolean (Single) ❂ prompt: Medication monitoring/diagnostic evaluation itemCode: 395170001 |Medication monitoring (regime/therapy)| response: Boolean (Single) responseBinding: Property ("MedicationMonitoring") Condition:elm:Property

❂ prompt: Detail

❂ prompt: Manage adverse drug reaction related to pain medication itemCode: [363259005 |Patient management procedure (procedure)] ->(363702006 |Has fo-cus (attribute))->[292040004 |Analgesic adverse reaction (disorder)] response: Boolean (Single) responseBinding: Property ("Adverse") Condition:elm:Property

❂ prompt: Detail response: String (Single) prompt:

Follow-up re-sponse:

responseBinding: Property ("Followup")

☐ prompt: Date and time response: Timestamp (Single) ☐ prompt: Detail

Chapter 16. Tabular List Terminology Service Request (TSR) Mappings

Table 16.1. Terminology Versions

Name Identifer Version

SNOMED CT 2.16.840.1.113883.6.96 United States Edition 20180301

Table 16.2. Terminology References

System Code Display Texta Referencesb

SNOMED CT 05257e84-e247-4f2e-bb83-dccd395d56a8 |Mindful-ness therapy (procedure)|

Postcoordinated Expression 2

SNOMED CT 133936004 |Adult (per-son)|

Adult 1

SNOMED CT 1411000205104 |Compre-hensive metabolic panel (procedure)|

Precoordinated Expression 1

SNOMED CT 19997007 |Hypnotherapy (regime/therapy)|

Precoordinated Expression 2

SNOMED CT 225206006 |Sleep and rest interventions (procedure)|

Precoordinated Expression 1

SNOMED CT 226060000 |Stress man-agement (procedure)|

Precoordinated Expression 1

SNOMED CT 228565006 |Imagery tech-nique (regime/therapy)|

Precoordinated Expression 2

SNOMED CT 229064008 |Movement therapy (regime/therapy)|

Precoordinated Expression 1

SNOMED CT…

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