FY27 MIS-FUNDED BY GRANT (FBG) Master Data Set.pdf

FBG BHMS Data Specifications FY27 MIS-FUNDED BY GRANT (FBG) Master Data Set

5-14-2026

MH=Mental Health, SUD = Substance Use Disorder

MH-ONLY FIELDS (GR-72-GR-73) are required when GR-17 AgencyCode is a mental health program, and must be blank when GR-17 AgencyCode is a substance use disorder program SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 AgencyCode is a substance use disorder program, and must be blank when GR-17 AgencyCode is a mental health program

Data Element

Number Data Element Codes/Descriptions A I D Notes

GR-1 FirstName Max Length 50 characters (alpha only) √ √ √

GR-2 LastName Max Length 50 characters (alpha only) √ √ √

GR-3 AddressUnknown 0=No 1=Yes

GR-4 AddressLine1 Max length 255 characters. Street address, PO Box, Etc. √ √ √ Required if GR-3 is 0=No.

Must be blank if GR-3 is 1=Yes.

GR-5 AddressLine2 Max length 255 characters. Apartment, Suite, Unit, etc.

GR-6 City Max length 100 characters. √ √ √ Required if GR-3 is 0=No.

Must be blank if GR-3 is 1=Yes.

GR-7 State 2 characters √ √ √ Required if GR-3 is 0=No.

Must be blank if GR-3 is 1=Yes.

GR-8 ZipCode 5 or 9 digits √ √ √ Required if GR-3 is 0=No.

Must be blank if GR-3 is 1=Yes.

GR-9 PhoneNumber 10 digits (numeric only) GR-10 Email Max Length 50 characters (alpha and numeric) GR-11 ClientID 14-digit (alpha and numeric) algorithm (see FY27 MIS-FUNDED BY GRANT

(FBG) Data Rules for details)

GR-12 DateOfBirth mm/dd/yyyy mm-dd-yyyy mm,dd,yyyy mmddyyyy yyyy/mm/dd yyyy-mm-dd yyyy,mm,dd

GR-13 Sex (The client's immutable biological classification as either male or female) Changed to reflect updated HHS guidance

1=Male 2=Female 3=Unknown

GR-14 GenderIdentity (One’s internal, personal sense of their gender)

See FY27 MIS-FUNDED BY GRANT (FBG) Data Rules for definitions

1=Cisgender Male 2=Cisgender Female 3=Transgender Man/Trans Man/Female-To-Male 4=Transgender Woman/Trans Woman/Male-To-Female 5=Genderqueer/Gender Non-Conforming/Neither Exclusively Male Nor Female 6=Additional Gender Category (or Other) 9=Unknown/Preferred Not to Respond

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

Client Demographic Data

REQUIRED FIELDS

5/14/2026 Page 1 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-15 SexualOrientation (Describes the emotional, romantic, and/or physical feelings of attraction-usually over a period of time)

See FY27 MIS-FUNDED BY GRANT (FBG) Data Rules for definitions

1=Straight or Heterosexual 2=Lesbian or Gay 3=Bisexual 4=(not a valid code) 5=Additional Sexual Orientation Category (or Other) 6=Queer 7=Pansexual 8=Questioning 9=Unknown/Preferred Not to Respond 10=Asexual

GR-16 ProviderClientID Agency specific, 0-30 alphanumerics, can have spaces and hyphens but no other special characters

GR-17 AgencyCode Enter the six-digit FUNDED BY GRANT (FBG) agency code of the provider program delivering services. If multiple programs are provided, enter a record for each FBG agency code providing services.

GR-18 SocialSecurityNumber The last 4 characters must match last 4 characters of Client ID. Must be 9 characters.

GR-19 TransactionStatus 1=A Admission 2=D Discharge 3=(not a valid code) 4=I Interim (key data updates) 5=(not a valid code)

√ √ √ Must update on I's

GR-20 TransactionDate mm/dd/yyyy mm-dd-yyyy mm,dd,yyyy mmddyyyy yyyy/mm/dd yyyy-mm-dd yyyy,mm,dd

√ √ √ Must update on I's

GR-21 FirstContactDate (The date of the client's first inquiry for services for the current treatment episode) mm/dd/yyyy mm-dd-yyyy mm,dd,yyyy mmddyyyy yyyy/mm/dd yyyy-mm-dd yyyy,mm,dd

√ Required on A. The value on I's and D must match the value on A.

GR-22 DeclinedAppt (Did client decline the earliest offered appointment?)

1=Yes 2=No

√ Required on A. The value on I's and D must match the value on A.

5/14/2026 Page 2 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-23 Race** 1=White 2=Black 3=Native American/Alaskan 4=Asian 5=(not a valid code) 6=Native Hawaiian/Other Pacific Islander 7=More Than One Race Reported 8=Other Race Not Listed 9=Unknown

√ Required on A. The value on I's and D must match the value on A.

**This field counts in the MIS Data Completeness Rule

GR-24 HispanicOrigin** 1=(not a valid code) 2=Not of Hispanic Origin 3=Cuban 4=Puerto Rican 5=Mexican 6=Other Hispanic 7=Unknown

√ Required on A. The value on I's and D must match the value on A.

**This field counts in the MIS Data Completeness Rule

GR-25 MedicaidNumber Must be 9 or 10 digits (Required when available) If eligible for Medicaid and/or the BHC Benefit Plan, enter Medicaid number on an A or I when available.

5/14/2026 Page 3 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-26 CountyOfResidence** (The county in which the client normally lives and has a mailing address)

1=Natrona 2=Laramie 3=Sheridan 4=Sweetwater 5=Albany 6=Carbon 7=Goshen 8=Platte 9=Big Horn 10=Fremont 11=Park 12=Lincoln 13=Converse 14=Niobrara 15=Hot Springs 16=Johnson 17=Campbell 18=Crook 19=Uinta 20=Washakie 21=Weston 22=Teton 23=Sublette 98=Non-Wyoming Resident 99=Unknown

√ √ √ **This field counts in the MIS Data Completeness Rule

GR-27 Employment (Current employment status)

1=Unemployed: Employable; no work available 2=Part Time: less than 30 hours per week 3=Full Time: greater than or equal to 30 hours per week 4=Homemaker: Adult not in workforce 5=Retired: Retired from active employment 6=Disabled Unemployed: Unable to work for disability reasons 7=Child: Under 16 years of age, not in the labor force 8=Student: 16 years of age or older, not in the labor force.

9=Inmate of an Institution 10=(not a valid code) 11=(not a valid code) 12=Volunteer Position

√ √ √ Must update on I's

5/14/2026 Page 4 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-28 Residence** (Current residential status)

1=Lacks a fixed, regular, night-time residence (includes shelters, time-limited transitional housing, street, vehicle, or succession of friends/relatives) 2=Private Residence/Household 3=Group Home 4=Residential Treatment Center 5=Boarding/Foster Home 6=Jail/Correctional Facility 7=Hospital 8=Other Residential Setting 9=Unknown 10=Nursing Home

√ √ √ Must update on I's **This field counts in the MIS Data Completeness Rule

GR-29 MaritalStatus** (Current marital status)

1=Never Married 2=Now Married 3=Legally or Otherwise Absent 4=Divorced 5=Widowed 6=Minor Child 7=Unknown

√ √ √ **This field counts in the MIS Data Completeness Rule

GR-30 VeteranStatus** (Has the client served in the uniformed services?)

1=Veteran: Non-Combat 2=Not a Veteran 3=Veteran: Combat 9=Unknown

√ Required on A. The value on I's and D must match the value on A.

**This field counts in the MIS Data Completeness Rule

5/14/2026 Page 5 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-31 Education** (Highest completed level of schooling)

0=No Schooling 1=Kindergarten or 1st Grade 2=2nd Grade 3=3rd Grade 4=4th Grade 5=5th Grade 6=6th Grade 7=7th Grade 8=8th Grade 9=9th Grade 10=10th Grade 11=11th Grade 12=High School Degree/GED 13=1 Year of College 14=2 years of College/Associates Degree 15=3 Years of College 16=Bachelors Degree 17=(not a valid code) 18=Masters Degree 19=(not a valid code) 20=Doctoral Degree Value 21-24 (not valid codes) 99=Unknown

√ √ √ **This field counts in the MIS Data Completeness Rule

GR-32 Referral** (Source of referral at admission)

1=Self 2=Family/Friends 3=Police/Law Enforcement 4=Court (not Title 25 clients) 5=Private Psychiatrist 6=Other Physician 7=Other Private Mental Health Practitioner 8=Clergy 9=Wyoming State Hospital 10=Other Inpatient Psychiatric Service 11=Drug/Alcohol Abuse Treatment Center 12=(not a valid code) 13=Shelter 14=Behavioral Health Center 15=Other

√ Required on A. The value on I's and D must match the value on A.

**This field counts in the MIS Data

5/14/2026 Page 6 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

Referral (continued) 16=Schools 17=Employer 18=DFS (Department of Family Services) 19=DVR (Division of Vocational Rehabilitation) 20=Nursing Home 21=Medical Hospital 22=DD (Developmental Disability) 23=Drug Court 24=(not a valid code) 25=Adult Probation and Parole 26=Juvenile Probation (DFS) 27=Early Childhood Setting 28=Attorney 29=Veterans Affairs 30=Department of Corrections 31=Court Order (Title 25 clients) 32=Social Security/Disability 33=WLRC (Wyoming Life Resource Center) 34=988 System 35=Youth Crisis Center 36=Wyoming Behavioral Institute 37=Avel E-Care 99=Unknown

GR-33 PrimaryIncomeSource** 1=Self 2=Family (Parent/Guardian/Spouse/Adult Children) 3=SSI (Supplemental Security Income) 4=SSDI (Social Security Disability Income) 5=Other Disability 6=Retirement 7=DFS (Department of Family Services/Welfare) 8=Other/Unemployment 99=Unknown

√ √ √ **This field counts in the MIS Data Completeness Rule

GR-34 ProbationUnderSupervision (Probation status identifies the client under supervision by the court at the time of granting probation or at any later time in accordance with Wyo. Stat. Ann. § 7-13- 410(b).)

1=Yes – I am currently on Probation Under Supervision (at Transaction Date) 2=No – I am not currently on Probation Under Supervision (at Transaction Date)

5/14/2026 Page 7 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-35 ProbationNotUnderSupervision (Probation status identifies whether the client is currently serving a sentence through the courts without confinement which imposes conditions of the sentence in accordance with Wyo. Stat. Ann. § 7-13- 401(a)(x).)

1=Yes – I am currently on Probation Not Under Supervision (at Transaction Date) 2=No – I am not currently on Probation Not Under Supervision (at Transaction Date)

GR-36 Parole (Parole status identifies whether the client is currently on a conditional release from an institutional confinement or imprisonment in accordance with Wyo. Stat. Ann. § 7-13- 401(a)(vii).)

1=Yes – I am currently on Parole (at Transaction Date) 2=No – I am not currently on Parole (at Transaction Date)

GR-37 FirstPresentingProblem (The client's primary complaint at the time of service)

1=Marital/Family 2=Social 3=Coping 4=Medical 5=Mood Disorder 6=Suicide 7=Alcohol 8=Drugs 9=Criminal Justice System 10=Eating Disorder 11=Thought Disorder 12=Abuse/Assault/Rape Victim 13=Runaway Behavior 14=Perpetrator 15=Evaluation 16=Gambling

Treatment Data

5/14/2026 Page 8 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-38 SecondPresentingProblem (The client's secondary complaint at the time of service)

0=Not Applicable 1=Marital/Family 2=Social 3=Coping 4=Medical 5=Mood Disorder 6=Suicide 7=Alcohol 8=Drugs 9=Criminal Justice System 10=Eating Disorder 11=Thought Disorder 12=Abuse/Assault/Rape Victim 13=Runaway Behavior 14=Perpetrator 15=Evaluation 16=Gambling

GR-39 ThirdPresentingProblem (The client's tertiary complaint at the time of service)

0=Not Applicable 1=Marital/Family 2=Social 3=Coping 4=Medical 5=Mood Disorder 6=Suicide 7=Alcohol 8=Drugs 9=Criminal Justice System 10=Eating Disorder 11=Thought Disorder 12=Abuse/Assault/Rape Victim 13=Runaway Behavior 14=Perpetrator 15=Evaluation 16=Gambling

5/14/2026 Page 9 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-40 FourthPresentingProblem (The client's quaternary complaint at the time of service)

0=Not Applicable 1=Marital/Family 2=Social 3=Coping 4=Medical 5=Mood Disorders 6=Suicide 7=Alcohol 8=Drugs 9=Criminal Justice System 10=Eating Disorder 11=Thought Disorder 12=Abuse/Assault/Rape Victim 13=Runaway Behavior 14=Perpetrator 15=Evaluation 16=Gambling

GR-41 Diagnosis1 Refer to Appendix F for valid ICD-10 codes √ √ √ GR-42 Diagnosis2 Refer to Appendix F for valid ICD-10 codes GR-43 Diagnosis3 Refer to Appendix F for valid ICD-10 codes GR-44 Diagnosis4 Refer to Appendix F for valid ICD-10 codes GR-45 Diagnosis5 Refer to Appendix F for valid ICD-10 codes GR-46 Diagnosis6 Refer to Appendix F for valid ICD-10 codes GR-47 DLA20HealthPractices

(DLA-20: Health Practices) 1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

5/14/2026 Page 10 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-48 DLA20Housing (DLA-20: Housing Stability, Maintenance)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-49 DLA20Communication (DLA-20: Communication)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 11 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-50 DLA20Safety (DLA-20: Safety)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, D, and I for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-51 DLA20Time (DLA-20: Managing Time)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, D, and I for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 12 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-52 DLA20Money (DLA-20: Managing Money)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-53 DLA20Nutrition (DLA-20: Nutrition)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, D, and I for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 13 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-54 DLA20ProblemSolving (DLA-20: Problem Solving)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, D, and I for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-55 DLA20Family (DLA-20: Family Relationships)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 14 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-56 DLA20AlcoholDrug (DLA-20: Alcohol/Drug Use)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-57 DLA20Leisure (DLA-20: Leisure)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 15 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-58 DLA20Community (DLA-20: Community Resources)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-59 DLA20Social (DLA-20: Social Network)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 16 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-60 DLA20Sexuality (DLA-20: Sexuality)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-61 DLA20Productivity (DLA-20: Productivity)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 17 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-62 DLA20Coping (DLA-20: Coping Skills)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-63 DLA20Behavioral (DLA-20: Behavioral Norms)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 18 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-64 DLA20Hygiene (DLA-20: Personal Hygiene)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-65 DLA20Grooming (DLA-20: Grooming)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

5/14/2026 Page 19 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-66 DLA20Dress (DLA-20: Dress)

1=Extremely severe functional impairment, needs pervasive level of continuous paid supports 2=Very severe functional impairment, needs extensive level of continuous paid supports 3=Severe functional impairment, needs moderate level of continuous paid supports 4=Moderate functional impairment, needs low level of continuous paid supports 5=WNL/Strength, Mild functional impairment, needs moderate level of intermittent paid supports 6=WNL/Strength, Intermittent mild functional impairment, needs low level of paid supports 7=WNL/Strength, Independent, Optimal functioning, no need for paid supports

√ √ √ Required on A, I, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Must enter scores for at least 15 of the 20 DLA-20 activity fields (GR-47 through GR-66).

Must update on I's.

GR-67 DLA20Score (DLA-20: Average Score) (DLA-20 Average Score is calculated by finding the sum of the reported activity scores (GR-47 through GR-66) divided by the number of reported activities)

Range 1.00 - 7.00 (must use 2 decimals) √ √ √ Required on A, I's, and D for all clients aged 6 and over.

Must be blank for clients under age 6.

Records with an incorrect DLA-20 Average Score will be rejected with an error message indicating the correct score.

5/14/2026 Page 20 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-68 DischargeStatus 1=Treatment Completed (Majority of the treatment plan or program was completed) 2=AMA (Against Medical Advice. Self terminated treatment when client clearly does not follow through with treatment recommendations) 3=Terminated by Facility (Treatment terminated by action of facility--not because client dropped out of treatment or client incarcerated or other client reason, documentation of steps taken for solution and explaining why termination was necessary) 4=Transferred to Another Facility (Client was transferred to another substance use disorder or mental health treatment program, provider or facility) 5=Evaluation Only (Client evaluated without agency intention to treat client) 6=Death (Patient/Client Died) 7=Other (e.g. Illness, hospitalization, or other reason somewhat out of client’s control) 8=Incarcerated (Jail, prison, or house confinement) 9=(not a valid code) 10=No Show (Client makes appointments but never returns for services) 11= Automatically Discharged by BHMS (This value is used internally by BHMS only) 12=Moved 13=Recommended for Another Level of Treatment 14=(not a valid code) 15=(not a valid code) 16=(not a valid code)

√ Cannot be blank on D. Must be blank on A and I's

GR-69 SchoolAttendance (Has the school-age client attended school at any time in the past 3 months? Applies to clients who are: 1) aged 5- 17 or 2) 18-21-year-olds covered under the IDEA act)

0=Not Applicable (not a school-aged client) 1=Yes 2=No 3=Not Applicable (school-aged client, but has been on summer vacation)

√ √ √ Must update on I's

GR-70 SchoolSuspension (Has the school-age client been suspended from school in the last 12 months? Applies to clients who are: 1) aged 5- 17 or 2) 18-21-year-olds covered under the IDEA act)

0=Not Applicable (Not a school-aged client) 1=Yes (Suspended) 2=No (Not Suspended) 9=Unknown

√ √ √ **This field counts in the MIS Data

5/14/2026 Page 21 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-71 TobaccoUse (Has the client used tobacco in the last 30 days?)

0=Never Used 1=Yes (Traditional Cigarettes/Cigars/Pipes) 2=No 3=E-Cigarettes 4=Snuff/Chew 5=More than One Form of Tobacco 8=No Use Due to Recent Stay in Controlled Environment

√ √ √ Must update on I's

GR-72 MHPopulation 0=Not SED/SMI 1=(not a valid code) 2=(not a valid code) 3=SED at Transaction Date 4=SMI at Transaction Date

√ √ √ MH-ONLY FIELDS (GR-72-GR-73) are required when GR-17 is an MH program, and must be blank when GR-17 is an SUD program

GR-73 MHArrest** (Has the client been arrested in the last 90 days? Includes any type of arrests, not just MH-related ones. Includes arrests for DUI. Does not imply conviction)

1=Yes (Arrested) 2=No (Not Arrested) 9=Unknown

√ √ √ MH-ONLY FIELDS (GR-72-GR-73) are required when GR-17 is an MH program, and must be blank when GR-17 is an SUD program Must update on I's **This field counts in the MIS Data Completeness Rule

GR-74 SANumberOfArrests** (How many times has the client been arrested in the last 30 days? Includes any type of arrests, not just SA-related ones. Includes arrests for DUI. Does not imply conviction)

0=None 1=1 2=2 3=3 4=More than 3 9=Unknown

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program Must update on I's **This field counts in the MIS Data Completeness Rule

GR-75 PrescriptionForMAT If the client is receiving Medication Assisted Treatment, which medication is being prescribed?

0=Not Applicable (client is not receiving MAT services or is not in a SOR program) 1=Buprenorphine 2=Methadone 3=Naltrexone 4=Buprenorphine and Naltrexone

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

Mental Health Only Fields

Substance Use Disorder Only Fields

5/14/2026 Page 22 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-76 SADrugProblemOne (The client's first drug problem) The client's primary drug problem (One, Two, Three, or Four) is indicated in field GR-96 Primary Indicator

1=Heroin 2=Non-Rx Methadone 3=Other Opiates and Synthetics 4=Alcohol 5=Barbiturates 6=Other Sedatives 7=Other Amphetamines 8=Cocaine 9=Marijuana/Hashish 10=Hallucinogens 11=Inhalants 12=Over-the-Counter 13=Tranquilizers 14=PCP/Other Hallucinogens 15=Other 16=Methamphetamine 17=Other Stimulants 18=Benzodiazepines 19=MDMA/Ecstasy 20=Rohypnol

21=GHB/GBL

22=Ketamine 23=Clonazepam 24=Buprenorphine 25=Fentanyl 26=Kratom

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-77 SAAgeAtFirstUseOne** (The age when the client used the substance in Drug Problem One for the first time)

0=Unknown 1-99=Age when first used substance from Drug Problem 1

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program **This field counts in the MIS Data Completeness Rule

GR-78 SAFrequencyOfUseOne (The frequency the client has used the substance in Drug Problem One in the last 30 days)

0=No Use 1=Less Than Once Per Week 2=Once Per Week 3=Several Times Per Week 4=Once Daily 5=Two to Three Times Daily 6=More Than Three Times Daily 7=(not a valid code) 8=No Use Due to Recent Stay in Controlled Environment

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

5/14/2026 Page 23 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-79 SARouteOfAdministrationOne** (The client's route of administration for the substance in Drug Problem One)

0=(not a valid code) 1=Oral 2=Smoking 3=Inhalation 4=Intramuscular 5=Intravenous 6=Unknown

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program **This field counts in the MIS Data Completeness Rule

GR-80 PrescriptionDrugOne (Is the substance in Drug Problem One considered to be prescription drug abuse (using a prescribed drug in a non-prescribed way)?)

1=Yes 2= No

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-81 SADrugProblemTwo (The client's second drug problem) The client's primary drug problem (One, Two, Three, or Four) is indicated in field GR-96 Primary Indicator

0=None 1=Heroin 2=Non-Rx Methadone 3=Other Opiates and Synthetics 4=Alcohol 5=Barbiturates 6=Other Sedatives 7=Other Amphetamines 8=Cocaine 9=Marijuana/Hashish 10=Hallucinogens 11=Inhalants 12=Over-the-Counter 13=Tranquilizers 14=PCP/Other Hallucinogens 15=Other 16=Methamphetamine 17=Other Stimulants 18=Benzodiazepines 19=MDMA/Ecstasy 20=Rohypnol

21=GHB/GBL

22=Ketamine 23=Clonazepam 24=Buprenorphine 25=Fentanyl 26=Kratom 99=Unknown

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and

5/14/2026 Page 24 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-82 SAAgeAtFirstUseTwo (The age when the client used the substance in Drug Problem Two for the first time)

0=Unknown/Not Applicable 1-99=Age when first used substance from Drug Problem 2

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-83 SAFrequencyOfUseTwo (The frequency the client has used the substance in Drug Problem Two in the last 30 days)

0=No Use 1=Less Than Once Per Week 2=Once Per Week 3=Several Times Per Week 4=Once Daily 5=Two to Three Times Daily 6=More Than Three Times Daily 7=(not a valid code) 8=No Use Due to Recent Stay in Controlled Environment

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and

Must update on I's

GR-84 SARouteOfAdministrationTwo (The client's route of administration for the substance in Drug Problem Two)

0=None 1=Oral 2=Smoking 3=Inhalation 4=Intramuscular 5=Intravenous 6=Unknown

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-85 PrescriptionDrugTwo (Is the substance in Drug Problem Two considered to be prescription drug abuse (using a prescribed drug in a non-prescribed way)?)

0=None 1=Yes 2=No

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and

5/14/2026 Page 25 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-86 SADrugProblemThree (The client's third drug problem) The client's primary drug problem (One, Two, Three, or Four) is indicated in field GR-96 Primary Indicator

0=None 1=Heroin 2=Non-Rx Methadone 3=Other Opiates and Synthetics 4=Alcohol 5=Barbiturates 6=Other Sedatives 7=Other Amphetamines 8=Cocaine 9=Marijuana/Hashish 10=Hallucinogens 11=Inhalants 12=Over-the-Counter 13=Tranquilizers 14=PCP/Other Hallucinogens 15=Other 16=Methamphetamine 17=Other Stimulants 18=Benzodiazepines 19=MDMA/Ecstasy 20=Rohypnol

21=GHB/GBL

22=Ketamine 23=Clonazepam 24=Buprenorphine 25=Fentanyl 26=Kratom 99=Unknown

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-87 SAAgeAtFirstUseThree (The age when the client used the substance in Drug Problem Three for the first time)

0=Unknown/Not Applicable 1-99=Age when first used substance from Drug Problem 3

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-88 SAFrequencyOfUseThree (The frequency the client has used the substance in Drug Problem Three in the last 30 days)

0=No Use 1=Less Than Once Per Week 2=Once Per Week 3=Several Times Per Week 4=Once Daily 5=Two to Three Times Daily 6=More Than Three Times Daily 7=(not a valid code) 8=No Use Due to Recent Stay in Controlled Environment

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and

5/14/2026 Page 26 of 33 and must be blank when GR-17 AgencyCode is a substance use disorder program

BHMS Data Specifications

**MIS Data Completeness Rule: An MIS form is only allowed up to 4 Unknowns in all of the marked fields.

A=Admission record I=Interim record D=Discharge record

FY27 MIS-FUNDED BY GRANT (FBG)

Master Data Set 5/14/2026

Note: FY27 changes to existing values are in red text. New fields for FY27 are highlighted in blue.

REQUIRED FIELDS

GR-89 SARouteOfAdministrationThree (The client's route of administration for the substance in Drug Problem Three)

0=None 1=Oral 2=Smoking 3=Inhalation 4=Intramuscular 5=Intravenous 6=Unknown

√ √ √ SUD-ONLY FIELDS (GR-74-GR-102) are required when GR-17 is an SUD program, and must be blank when GR-17 is an MH program

GR-90 PrescriptionDrugThree (Is the substance in Drug…