Crosswalk Management System - · Crosswalk Management System. ... K = Key Field Item NoTreatment Episode Data Set Item Value State System Data ... Post Graduate Study Grade 2 Nursery

REPORT CROSSWALK TO STATE

23-DEC-16 11:41Report Date :

Run by :

Report :

CWMS_PROXY

Filename :

Crosswalk Management System

CWMS_PROXY

Crosswalk Report

Page 2 of 80

Status : FN

Start Date : 01-JAN-90End Date :

Follow-up :

Media ID : WVADAS/CDS now APS-WV

West VirginiaSystem

K

1

2

3

System Transaction Type

State Code

Reporting Date

A

C

D

Add

Change

Delete

Add

Change

Delete

System Transaction Type Added To Each Record

FIPS Code Added To Each Record

Month And Year Of Submission Added To Each Record

-

-

-

K = Key Field

Treatment Episode Data SetItem No Item Value State System Data

Substance Abuse and Mental Health Services AdministrationCenter for Behavioral Health Statistics and Quality

West Virginia's Treatment Episode Data SetVersion : 1

A

C

D

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West VirginiaMinimum

K

K

K

K

K

K

1

1

2

2

3

3

State Provider Identifer

State Provider Identifer

Client Identifer (Admission)

Client Identifer (Admission)

Co-Dependent/Collateral

Co-Dependent/Collateral

1

2

1

2

Yes

No

Yes

No

Yes

No

Yes

No

Provider ID = AID

Provider ID = AID (MFED)

Client ID = MCI

Client ID = MCI (MFED)

Collateral

Receiving Serv Co-depend/collaterals

--

--

--

--

--

13

K = Key Field



1

2

1

2

No longer effective as of:



02-03-2015

02-03-2015

02-03-2015

CWMS_PROXY

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K

K

4

4

Client Transaction Type

Client Transaction Type

1

2

8

9

1

1

1

2

3

3

8

8

9

9

New Admission

Readmission of Closed Case

Change in Level of Care

Update/Reassessment of Open Case

New Admission

New admission

New admission

Readmission of closed case

Update/Reassessment of open case (inactive)

Update/Reassessment of Open Case (inactive)


Change in level of care

update

Update

Admission (SA)

Admission (SA)

Transfer/Change in Service (SA)


Admission (SA)

Admission (SA)

Initial Admission (MH)


Transfer or Change in Service (MH)






Case Status

Case Status (Field 15, CC_Core)

9

--

K = Key Field



A

A

T

T

A

A

M

M

X

T

X

T

T

X

No longer effective as of: 02-03-2015

CWMS_PROXY

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K

K

5

5

6

Date of Admission

Date of Admission

Prior Treatment Episodes

-

0

1

2

3

4

5

7

MMDDYYYY

0

1

2

3

4

5 or more

Unknown

mmddyyyy

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

Unknown

Service Start Date (Field 10, BDS)

Date Form

Number SA Admissions (Item 50 Child form)

--

7

90

K = Key Field



m/d/y

0

1

2

3

4

5

7



02-03-2015

02-03-2015

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6 Prior Treatment Episodes

0

1

2

3

4

5

0

1

2

3

4

5 or more

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

Admissions (Field 16, BDS)--

K = Key Field



0

1

2

3

4

5

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7 Principal Source of Referral

1

2

26

3

32

34

4

40

41

42

43

44

46

47

48

49

5

98

Individual/Self

Family or Friend

Employer/Employee Assistance Program

Police

Mental Hygiene

Drug Court

Court or Correction Agency

Alcohol/Drug Abuse Care Provider

Diversionary Program

DUI/DWI

Mental Health Care Provider

Other Community Referral

Other Health Care Provider

Prison

Probation/Parole

State/Federal Court

School System or Education Agency

Unknown

Individual (includes self-referral))


Employer/Employer Assistance ProgramEAP

Court/Criminal Justice/DUI/DWI




Alcohol/Drug Abuse Provider









School (Educational)

Unknown

CRefferalSource (Field 53, CC_Core)--

K = Key Field



01

01

05

07

03

07

07

02

07

07

03

06

03

07

07

07

04

97

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7 Principal Source of Referral

01

02

03

04

05

26

32

34

40

41

42

43

44

45

46

47

48

49

Individual or Self

Family or Friend

Police



Employer/EAP

Mental Hygiene

Drug Court

Alcohol/Drug Abuse Care Provider


DUI/DWI

Mental Health Care Provider


Other Court


Prison

Probation/Parole

State/Federal Court






Employer/Employer Assistance ProgramEAP



Alcohol/Drug Abuse Provider










Referring Entity Field53 CC_Core(Item 34 on Child Form)

44

K = Key Field



01

01

07

07

04

05

03

07

02

07

07

03

06

07

03

07

07

07

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7

8

8

9

9

Principal Source of Referral

Date of Birth

Date of Birth

Gender

Gender

97

mmddyyyy

-

0

1

2

0

1

2

Unknown

Date of birth (maximum age is 95 (DOA-DOB)

MMDDYYYY

Unknown

Male

Female

Unknown

Male

Female

Unknown

Date of birth

Date of birth

Unknown

Male

Female

Unknown

Male

Female

Referring Entity Field53 CC_Core(Item 34 on Child Form)

Birth Date (same on adult & child forms)

CDOB (Field 7, MCI)

Cgender (Field 8, MCI)

Gender (Item #13 on Child form)

44

42

--

--

43

K = Key Field



97

MMDDYYYY

MMDDYYYY

7

1

2

7

1

2




02-03-2015

02-03-2015

02-03-2015

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10 Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit

0

1

2

3

4

5

6

7

8

Unknown

American Indian

Alaska Native

Asian

African American/Black

Hawaiian/Pacific Islander

White

Other

Multi Racial

Unknown

American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other

Alaska Native (Aleut, Eskimo, Indian)

Asian

Black or African American

Native Hawaiians or Other Pacific Islanders

White

Other Single Race

Two or More Races

CRACE (Field 16, MCI)--

K = Key Field



97

02

01

13

04

23

05

20

21

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10 Race (Hispanic collected as race to be reported as 97 in Race and 06 in Ethnicit

00

01

02

03

04

05

06

07

08

Unknown

American Indian

Alaska Native

Asian



White

Other

Multi Racial

Unknown

American Indian/Alaskan Native ( States using Alaskan Native in 01 use for other

Alaska Native (Aleut, Eskimo, Indian)

Asian


Native Hawaiians or Other Pacific Islanders

White

Other Single Race

Two or More Races

Race (Item #15 on Child form)45

K = Key Field



97

02

01

13

04

23

05

20

21


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11

11

Hispanic or Latino Origin ( Ethnicity)

Hispanic or Latino Origin ( Ethnicity)

08

09

10

11

12

13

14

10

11

12

13

14

8

9

Not of Hispanic Origin

Puerto Rican

Mexican

Cuban

Other Specific Hispanic

Hispanic, Specific Origin Not Specified

Unknown

Mexican

Cuban


Hispanic or Latino - specific origin not specified

Unknown

Not of Hispanic Origins

Puerto Rican

Not of Hispanic or Latino Origin

Puerto Rican

Mexican

Cuban


Hispanic or Latino - Specific Origin not Specified

Unknown

Mexican

Cuban


Hispanic or Latino - Specific Origin not Specified

Unknown

Not of Hispanic or Latino Origin

Puerto Rican

Ethnicity (Item #16 on Child form)

Hispanic (Field 17, MCI)

46

--

K = Key Field



05

01

02

03

04

06

97

02

03

04

06

97

05

01


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12 Education

0

1

1

10

10

11

11

12

13

13

14

15

16

17

18

19-25

2

2

none

Grade 1

Preschool Program {Educ_Status}

Graduate or Professional School {Educ_Status}

Grade 10

Post Graduate School {Educ_Status}

Grade 11

Grade 12

Grade 13

Kindergarten {Educ_Status}

Grade 14

Grade 15

Grade 16

Grade 17

Grade 18

Grade 19-25

Grade 2

Headstart {Educ_Status}

Less Than One Grade Completed

Grade 1

Nursery school, Preschool, Headstart

Graduate or Professional school - medical, law - includes Master's and Doctorate

Grade 10

Graduate or Professional school - medical, law - includes Master's and Doctorate

Grade 11

12th Grade or GED

1st year of College/Iniversity (Freshman)

Kindergarten

2nd year of College/Iniversity (Sophomore)

3rd year of College/Iniversity (Junior)

4th year of College/Iniversity (Senior) or Bachelor's Degree)

Some Post-Graduate Study - Degree not completed

Master's Degree Completed

Post Graduate Study

Grade 2

Nursery school, Preschool, Headstart

Grade_Level (Field 39, CC_Core) & Educ_Status (Field 40, CC_Core)

--

K = Key Field



00

01

72

70

10

70

11

12

13

73

14

15

16

17

18

19-25

02

72

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12 Education

26

3

4

4

5

6

6

7

8

8

9

Grade 26

Grade 3

Special Education {Educ_Status}

Grade 4

Grade 5

Grade 6

GED Program {Educ_Status}

Grade 7

Grade 8

Trade, Vocational or Technical {Educ_Status}

Grade 9

Post Graduate Study

Grade 3

Self-contained special education class

Grade 4

Grade 5

Grade 6

12th Grade or GED

Grade 7

Grade 8

Vocational school - business, technical,secretarial, trade or correspondence

Grade 9

Grade_Level (Field 39, CC_Core) & Educ_Status (Field 40, CC_Core)

--

K = Key Field



19-25

03

74

04

05

06

12

07

08

71

09

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12 Education

1-11

12

13

14

15

16

17-21+

97

grades 1 thru 11

HS/GED

Some College

2 Yr College

4 Yr College

Graduate

Graduate or Professional Degree

Unknown

Years of School(Highest Grade) ( General Equivalency Degree, use 12)







Unknown

Yrs Education (Item 20 &118 child form)56

K = Key Field



01-25

01-25

01-25

01-25

01-25

01-25

01-25

97


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13 Employment Status

02

03

04

05

06

07

08

09

10

12

13

14

15

16

17

Supported Work

Sheltered Work

In Employment Training

Not in Labor Force: Homemaker

Not in Labor Force: Student

Not in Labor Force: Retired

Not in Labor Force: Physically Impaired

Not Employed, Not Looking

Not Employed, But Looking

Volunteer

Competitive Employment - FT

Competitive Employment - PT

Not in Labor Force: Inmate of Institution

Not in Labor Force: Disabled

Not in Labor Force: Other

Part Time - works less tahn 35 hours per week



Not in Labor Force - not looking for work in past 30 days - stdent, retired etc.




Unemployed - looking for work in past 30 days or on layoff from job



Full Time - works 35 or more hours a week- includes military





Employment Stat (Field 35, CC_Core)22

K = Key Field



02

02

02

04

04

04

04

03

03

03

01

02

04

04

04


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13 Employment Status

10

11

12

13

14

15

16

17

2

3

4

5

6

7

8

9

Not Employed, But Looking

Not in Labor Force

Volunteer

Competitive Employment Full Time

Competitive Employment Part Time

Not in Labor Force, Inmate of Institution

Not in Labor Force, Disabled

Not in Labor Force, Other

Supported Employment

Sheltered Work

In Employment Training

Not in Labor Force, Homemaker

Not in Labor Force, Student

Not in Labor Force, Retired

Not in Labor Force, Physically Impaired


















Employment_Status (Field 35, CC_Core)--

K = Key Field



03

04

04

01

02

04

04

04

02

02

02

04

04

04

04

04

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14 Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

None

Alcohol

Cocaine/Crack

Marijuana/Hashish

Heroin

Non-Prescription Methadone

Other Opiates and Synthetics

PCP

Other Hallucinogens

Methamphetamine

Other Amphetamines

Other Stimulants

Benzodiazepines

Other Non-Benzodiazepine Tranquilizer

Barbiturates

Other Non-Barbiturate Sedatives or Hypnotics

Inhalants

None

Alcohol

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

Heroin



PCP

Hallucinogens

Methamphetamine

Other Amphetamines

Other Stimulants

Benzodiazepines

Other Non-Benzodiazapine Tranquilizers

Barbiturates

Other Non-Barbituate Sedatives or Hypnotics

Inhalants

Substance Abuse Problem17

K = Key Field



01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

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18

20

97

Over-The-Counter

Other

Unknown

Over-the-Counter

Other

Unknown

Substance Abuse Problem17

K = Key Field



18

20

97


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01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

Alcohol

Barbiturates

Benzodiazepines

Other Sedatives/Hypnotics

Other Tranquilizers

Heroin


Other Opiates/Synthetics

Methamphetamines

Other Amphetamines

Cocaine other than Crack

Crack

Marijuana, Hashish, THC

PCP

Other Hallucinogens

Inhalants

Over-the-Counter

Alcohol

Barbiturates

Benzodiazepines

Other Non-Barbituate Sedatives or Hypnotics

Other Non-Benzodiazapine Tranquilizers

Heroin



Methamphetamine

Other Amphetamines

Cocaine, Crack

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

PCP

Hallucinogens

Inhalants

Over-the-Counter

Substance Abuse Problem (derived from Fields 17,18,19 BDS)

--

K = Key Field



02

15

13

16

14

05

06

07

10

11

03

03

04

08

09

17

18

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14

15

Substance Problem Codes ( Primary-14A,Secondary-14B, Tertiart-14C)

Usual Route of Administration ( Primary-15A, Secondary-15B, Tertiar-15C)

18

1

2

3

4

5

6

Other

Oral

Nasal

Smoking

Injection

IV Injection

Other

Other

Oral

Inhalation

Smoking

Injection (IV or intramuscular, intradermal or subcutaneous)


Other

Substance Abuse Problem (derived from Fields 17,18,19 BDS)

Usual Route of Administration.

--

18,19,20

K = Key Field



20

01

03

02

04

04

20


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15

16

Usual Route of Administration ( Primary-15A, Secondary-15B, Tertiar-15C)

Frequency of Use ( Primary-16A, Secondary-16B, Tertiary-16C)

1

2

3

4

5

6

9

1

2

3

4

5

6

Oral

Nasal

Smoking

Injection

IV Injection

Other

Not Applicable

No use during the last 30 days

1-3 days use during last 30 days

1-2 days per week use during last 30 days


Daily use during last 30 days

Collateral

Oral

Inhalation

Smoking



Other

Not Applicable

No use in the past month

1-3 times in past month

1-2 times per week

3-6 times per week

Daily

Not Applicable

AdminRoute (Fields 20, 21, 22 BDS)

FreqDrug (Fields 24, 25, 26 BDS)

--

--

K = Key Field



01

03

02

04

04

20

96

01

02

03

04

05

96

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16 Frequency of Use ( Primary-16A, Secondary-16B, Tertiary-16C)

1

2

3

4

5

6

No use during last 30 days

1-3 days during the last 30 days

1-2 days per week during last 30 days

3-6 days per week during last 30 days

Daily during last 30 days

Collateral

No use in the past month

1-3 times in past month

1-2 times per week

3-6 times per week

Daily

Not Applicable

Frequency20

K = Key Field



01

02

03

04

05

96


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17 Age of First Use (Primary-17A, Secondary-17B, Tertiary-17C)

01

01

02

03

04

05

06

07

08

09

11

Under 12 years

Under 12 years

12-17

18-20

21-24

25-34

35-44

45-54

55-64

65 and over

Collateral

Newborn with a substance dependecy problem

Age at First Use, in years









Not Applicable

Age of First Use.21

K = Key Field



00

01-95

01-95

01-95

01-95

01-95

01-95

01-95

01-95

01-95

96


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17 Age of First Use (Primary-17A, Secondary-17B, Tertiary-17C)

1

11

2

3

4

5

6

7

8

9

Under 12 years

Collateral

12-17 years

18-20 years

21-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65 years and ove

Newborn with a substance dependecy problem

Not Applicable









AgeFirstUse (Fields 27, 28, 29 BDS)--

K = Key Field



00

96

01-95

01-95

01-95

01-95

01-95

01-95

01-95

01-95

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K

K

18

18

Type of Services

Type of Services

01

02

03

04

05

06

07

08

01

02

03

04

05

06

07

08

Hospital Inpatient

Free Standing

Hospital

Short Term < = 30 Days

Long Term > 30 Days

Intensive Outpatient

Outpatient

Detoxification

Detoxification, 24-hour services, hospital inpatient

Detoxification, 24-hour services, free-standing residential

Rehabilitation/residential - hospital (other than detoxification)

Rehabilitation/residential - short term (30 days or fewer)

Rehabilitation/residential - long term (more than 30 days)

Ambulatory - intensive outpatient

Ambulatory - non-intensive outpatient

Ambulatory - detoxification

Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Detoxification Free-standing Residential ( Detox, 24 hour Service)

Rehabilitation/Residential - Hospital (other thandetox)

Rehabilitation/Residential - Short-term, ( 30 days or fewer)

Rehabiliation/Residential - Long-term, ( more than 30 days)

Ambulatory - Intensive Outpatient

Ambulatory - Non-Intensive Outpatient

Ambulatory Detoxification

Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Detoxification Free-standing Residential ( Detox, 24 hour Service)

Rehabilitation/Residential - Hospital (other thandetox)

Rehabilitation/Residential - Short-term, ( 30 days or fewer)

Rehabiliation/Residential - Long-term, ( more than 30 days)




Services

Tcode (Field 1, Pcode)

9

--

K = Key Field



01

02

03

04

05

06

07

08

01

02

03

04

05

06

07

08


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19

19

Medication-Assisted Opioid Therapy

Medication-Assisted Opioid Therapy

8

8

Not Collected

Not collected

Not Collected

Not Collected

Not Funded (Medication-Assisted Opioid Therapy)

Use of Methadone Planned.

--

--

K = Key Field



8

8


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West VirginiaSupplementalK = Key Field



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Page 29 of 80

West VirginiaSupplemental

1 Detail Drug Code, Primary

0201

0301

0302

0401

0501

0601

0701

0702

0703

0704

0705

0706

0707

0708

0709

0710

0750

0751

Alcohol

Crack

Other Cocaine

Marijuana/Hashish, THC & any other cannabis sative preparations

Heroin

Methadone

Codeine

Propoxyphene (Darvon)

Oxycodone (Oxycontin)

Meperidine (Demerol)

Hydromorphone (Dilaudid)

Other Opiates or Synthetics

Pentazocine (Talwin)

Hydrocodone (Vicodin)

Tramadol (Ultram)

Buprenorphine (Subutex, Suboxone)

Butorphanol (Stadol)

Other Narcotic Analgesics

Alcohol

Crack

Other Cocaine

Marijuana/Hashish,THC and any other cannabis sativa preparation

Heroine

Methadone

Codeine

Propoxyphene (Darvon)

Oxycodone (Oxycotin)

Meperidine (Demerol)

Hydromorphone (Dilaudid)

Butorphanol(Stdol), Morphine(Mxcontin, Opium or other narcotic analgesics, opiat

Pentazocine (Talwin)

Hydrocodone (Vicodin)

Tramadol (Ultram)

Buprenorphine (Subutex,Suboxone)



Drug (Fields 17, 18, 19 BDS)~

K = Key Field



0201

0301

0302

0401

0501

0601

0701

0702

0703

0704

0705

0706

0707

0708

0709

0710

0706

0706

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0752

0801

0901

0902

0980

1001

1101

1103

1109

1201

1202

1301

1302

1303

1304

1305

1306

1307

1308

Morphone Sulfate (MSContin)

PCP

LSD

Other Hallucinogens

Bath Salts

Methamphetamine/Speed

Amphetamine

Methylenedioxymethamphetamine (MDMA, Ecstasy)

Other Amphetamines

Other Simulants

Methylphenidate (Ritalin)

Alprazolam (Xanax)

Chlordiazepoxide (Librium)

Clorazepate (Tranzene)

Diazepam (Valium)

Flurazepam (Dalmane)

Lorazepam (Ativan)

Triazolam (Halcion)

Other Benzodiazepines


PCP or PCP Combinations

LSD

DMT, mescaline, peyote,STD and Other Hallucinogens

Other Amphetamines

Methamphetamine/Speed

Amphetamine

Methyleneioxymethampetamine (MDMA, Ecstacy

Other Amphetamines

Other Stimulants

Methylphenidate - (Ritalin)

Alprazolam (Xanax)

Chlordiazepoxide (Librium)

Clorazepate (Tranzene)

Diazepam (Valium)

Flurazepam (Dalmane)

Lorazepam (Ativan)

Triazolam (Halcion)

Halazepam,oxazepam(Serax),Prazepam,Temazepam(Restoril) and other


K = Key Field



0706

0801

0901

0902

1109

1001

1101

1103

1109

1201

1202

1301

1302

1303

1304

1305

1306

1307

1308

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1309

1310

1403

1501

1502

1503

1509

1601

1602

1603

1604

1605

1701

1702

1703

1704

1705

1801

1809

Flunitrazepam (Rohypnol)

Clonazepam (Klonopin, Rivotril)

Other Tranquilizers

Phenobarbital

Secobarbital/Amobarbital (Tuinal)

Secobarbital (Seconal)

Other Barbiturate Sedatives

Ethcnlorvynol (Placidyl)

Glutethimide (Doriden)

Methaqualone (Quaalude)

Other Non-Barbiturate Sedatives

Other Sedatives

Aerosols

Nitrites

Other Inhalants

Solvents

Anesthetics

Diphenhydramine

Other over-the-counter drugs

Flutirazepram (Rohypnol)

Clonazepam - (Klonopin, Rivotril)

Other non-benzodiazepineTranquilizer

Phenobarbital

Secobarbital/Amobarbital (Tuinal)

Secobarbital (Seconal)

Other Barbiturate Sedatives

Ethclorvynol (Placidyl)

Glutethimide (Doriden)

Methaqualone



Aerosols

Nitrites

Gasoline,glue, and other inapproriately inhaled products

Solvents (paint thinners and other solvents)

Anesthetics (Choloform,ether, nitrous oxzide and other anesthetics)

Diphenhydramine

Other Over-The-Counter


K = Key Field



1309

1310

1403

1501

1502

1503

1509

1601

1602

1603

1604

1604

1701

1702

1703

1704

1705

1801

1809

CWMS_PROXY

Crosswalk Report

Page 32 of 80


1

1

4

Detail Drug Code, Primary

Detail Drug Code, Primary

Diagnostic Code (DSM or ICD) field should be coded 999.98 - field 19 replaces i

1850

1851

2001

2002

2003

2004

2050

9996

9997

9998

-

Ephedrine

Dextromethorphan (DXM)

Diphenylhydantoin/Phenytoin (Dilantin)

Other drugs

GHB/GBL (gamma-hydroxybutyrate, gamma-butyrolactone)

Ketamine (Special K)

Carisoprodol (Soma)

Not applicable

Unknown

Not collected

Not collected



Dephenylhydantoin/Phenytoin (Dilantin)

Synthetic Cannabinoid (Spice), Carisoprodol (Soma) and other drugs

GHB/GBL - ( gamma-hyroxybutyrate, gamma-butyrolactone)

Ketamine - ( Special K)

Synthetic Cannabinoid (Spice), Carisoprodol (Soma) and other drugs

Not Applicable

Unknown

Not Collected

Not Collected

Drug (Fields 17, 18, 19 BDS)

Drug Detail Codes

Axis1, Axis12, Axis13 (Fields 68, 69, 70 CC_Core)

~

~

~

K = Key Field



1809

1809

2001

2002

2003

2004

2002

9996

9997

9998

999.98


CWMS_PROXY

Crosswalk Report

Page 33 of 80


4

5

Diagnostic Code (DSM or ICD) field should be coded 999.98 - field 19 replaces i

Psychiatric Problem in Addition to Alcohol or Drug Problem

999.97

xxx.xx

1

4

5

7

Unknown

DSM-R category

Mental Health

MH & SA

MH & MR/DD

MH & SA & IDD

Unknown

DSM/ICD codes

No

Yes

No

Yes

DSM-IV Diag (96-103 adult form,60-68 child) Field 68,69,70

DG (Field 43, CC_Core)

95

~

K = Key Field



999.97

XXX.XX

2

1

2

1


CWMS_PROXY

Crosswalk Report

Page 34 of 80


5

6

Psychiatric Problem in Addition to Alcohol or Drug Problem

Pregnant at Admission

1

2

3

4

5

6

7

8

9

1

2

3

4

Mental Health

Substance Abuse

MR/DD

MH & SA

MH & MR/DD

SA & MR/DD

MH & SA & MR/DD

Early Childhood/Intervention

Public Inebriate

Yes

No

Do Not Know

No, Consumer is Male

Yes

No

No

Yes

Yes

Yes

Yes

Unknown

No

Yes - female client was pregnant at admission

No - female client was not pregnant at admission

Unknown

Not Applicable - use this code for male clients or children in prepuberty age

Client's Disability Group (Child form 12)

Currently Pregnant (55 on child form)

73

39

K = Key Field



1

2

2

1

1

1

1

7

2

1

2

7

6



02-03-2015

02-03-2015

CWMS_PROXY

Crosswalk Report

Page 35 of 80


6

7

7

Pregnant at Admission

Veteran Status

Veteran Status

1

2

4

1

2

3

1

2

3

Yes

No

Male

No

No, but spouse or dependent child of someone currently serving or veteran

Yes

No

No, but spouse or dependent child of someone currently serving or Veteran

Yes

Yes - female client was pregnant at admission

No - female client was not pregnant at admission

Not Applicable - use this code for male clients or children in prepuberty age

No

No

Yes

No

No

Yes

Pregnant (Field 15 BDS)

MilStat (Field 5, MSR)

U.S. Veteran

~

~

47

K = Key Field



1

2

6

2

2

1

2

2

1


CWMS_PROXY

Crosswalk Report

Page 36 of 80


8 Living Arrangements

1

1

10

11

12

13

13

14

15

15

16

16

17

17

18

18

19

19

Own or Rent Non-Subsidized House/Apartment

Own or Rent Non-Subsidized House/Apartment

Homeless / Homeless Shelter

Family Emergency Shelter

Youth Emergency Shelter

Adult Family Care home

Adult Family Care home

Independent Living Group Home

Regular Foster Home

Regular Foster Home

Treatment Foster Home


Specialized Family Care Home


Personal Care Home

Personal Care Home

Residential Group Treatment


Private residence , living arrangement not specified, adults (temporary code NH

Independent Living - clients living alone or with others but no supervision

Homeless - clients with no fixed address; includes homeless shelter



Dependent Living - clients living in a supervised setting

Dependent living: residential care (MH only)


Dependent living: foster home/foster care (MH only)










CLivingArrangement (Field 36 CC_Core)~

K = Key Field



04

03

01

01

01

02

22

03

32

02

32

02

32

02

22

02

02

22

CWMS_PROXY

Crosswalk Report

Page 37 of 80



2

2

20

20

21

21

22

22

23

23

24

24

25

25

26

27

27

28

28

Subsidized Rental House/Apartment


Large Group Board & Care Home


Small Group Board & Care Home


Wilderness Camp

Wilderness Camp

Rest Home

Rest Home

Nursing Home

Nursing Home

ICF-MR Group Home

ICF-MR Group Home

Medical Hospital

Acute Care Psychiatric Facility


Long-term Psychiatric Facility

Long-term Psychiatric Facility










Dependent living: institutional setting (MH only)











K = Key Field



04

03

22

02

22

02

02

22

02

52

02

52

02

52

02

02

52

02

52

CWMS_PROXY

Crosswalk Report

Page 38 of 80



29

3

3

30

30

31

31

32

32

33

33

34

34

35

35

36

4

4

5

Psychiatric Residential TX Facility

Supported Housing - Staff Supported


Adult Drug/Alcohol Rehabilitation Center


Youth Drug/Alcohol Rehabilitation Center


Dependent Living (includes Halfway Houses)


Independent Support Setting (ISS)


Youth Correctional Center


Adult Correctional Center


Inpatient Psychiatric Facility

Rooming House - Hotel - YMCA


Private Boarding House



Dependent living: adults in private residence who need assistance in (MH only)







Dependent living: adults in private residence who need assistance in (MH only)



Dependent living: jail and other institutions under the justice system (MH only)








K = Key Field



02

02

72

22

02

22

02

22

02

72

02

02

62

02

62

02

03

04

04

CWMS_PROXY

Crosswalk Report

Page 39 of 80



5

6

6

6

7

7

7

8

8

8

9

9


Home of Biological Parents (if client age < 18)

Home of Biological Parents (if client age >= 18)

Home of Biological Parents (if client age >= 18)

Adoptive Home (if client age >= 18)

Adoptive Home (if client age >= 18)

Adoptive Home (if client < 18)

Home of relative (if client >= 18)

Home of Relative (if client < 18)

Home of relative (if client >= 18)

Home of friend

Home of friend














K = Key Field



03

02

03

04

04

03

02

03

02

04

03

04

CWMS_PROXY

Crosswalk Report

Page 40 of 80



01

02

03

04

05

06

06

07

07

08

08

09

10

11

12

13

14

15

Own or Rent Non-Substidized House / Apartment





Home of Biological Parents (if Client age < 18)

Home of Biological Parents (if Client age >= 18)

Adoptive Home (if Client Age >= 18)

Adoptive Home (if Client Age < 18)

Home of Relative (if Client < 18)

Home of Relative (if Client >= 18)

Home of Friend

Homeless / Homeless Shelter



Adult Family Care Home


Regular Foster Home



















Living arrangements (Item 21Child form)49

K = Key Field



03

03

02

03

03

02

03

03

02

02

03

03

01

01

01

02

03

02

CWMS_PROXY

Crosswalk Report

Page 41 of 80



16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34



Personal Care Home


Large group board and care home (morethan 8)

Small group board and care home (less than 8)

Wilderness Camp

Rest Home

Nursing Home

ICF/MR Group Home

Medical Hosiptal

Acute Care Psychiatric Facililty

Long-Term Psychiatric Facility




Dependent Living ( includes halfway houses)






















Living arrangements (Item 21Child form)49

K = Key Field



02

02

02

02

02

02

02

02

02

02

02

02

02

02

02

02

02

02

02

CWMS_PROXY

Crosswalk Report

Page 42 of 80


8

9

Living Arrangements

Source of Income/Support

35

36

98

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes

1 - yes


Inpatient Psychiatric Facility

Other

Emp_Income

OtherAssistance

FoodStamps

PubHousing

mf_wic_assistance

FamilyIncome

VAPension

SSIncome

SSIncome

OtherIncome

TanfAssistance



Unknown

Wages/Salary

Public Assistance

Public Assistance

Public Assistance

Public Assistance

Other

Retirement/Pension

Retirement/Pension

Disability

Other

Public Assistance

Living arrangements (Item 21Child form)

Fields 30-40, BDS Yes/No question {income}

49

~

K = Key Field



02

02

97

01

02

02

02

02

20

03

03

04

20

02


CWMS_PROXY

Crosswalk Report

Page 43 of 80


9 Source of Income/Support

1

1

1

1

1

1

1

1

1

1

1

Yes, Emp_Income

Yes, OtherAssistance

Yes, FoodStamps

Yes, PubHousing

Yes, mf_wic_assistance

Yes, FamilyIncome

Yes, VAPension

Yes, SSIIncome

Yes, SSDIIncome

Yes, OtherIncome

Yes, TanfAssistance

Wages/Salary

Public Assistance

Public Assistance

Public Assistance

Public Assistance

Other

Retirement/Pension

Retirement/Pension

Disability

Other

Public Assistance

Income (Fields 28-38, Mfed)~

K = Key Field



01

02

02

02

02

20

03

03

04

20

02


CWMS_PROXY

Crosswalk Report

Page 44 of 80


10

10

Health Insurance

Health Insurance

1

1

1

1

1

1

1

1

03

04

06

10

11

12

13

14

Yes, Private_Insurance_Coverage

Yes, Medicare_Coverage

Yes, Medicaid_Coverage

Yes, OSS_Coverage

Yes, Waiver_Recipient

Yes, Other_Coverage

Yes, OBHS_Coverage

Yes, ICF_Recipient

Medicare

Medicaid

Other Government Payments

Private Insurance

Blue Cross/Blue Shield

HMO

Other (Champus)

Other

Private Insurance (other than BCBS or HMO)

Medicare

Medicaid

Other (e.g. TriCare)





Medicare

Medicaid


Private Insurance (other than BCBS or HMO)


Health Maintenance Organization (HMO)



Insurance carrier - (Fields 46-51 CC_Core)

Payor (Field 4, CSDR) {health insurance}

~

~

K = Key Field



01

03

04

20

20

20

20

20

03

04

20

01

02

06

20

20


CWMS_PROXY

Crosswalk Report

Page 45 of 80


11 Expected/Actual Primary Source of Payment

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

99

BHHF Service (OBHS)

Bureau of Children & Families

Medicare

Medicaid

Worker's Compensation


Self-pay

Targeted Funds

Charity Services

Private Insurance


HMO

Other (Champus)

Other

Maternal and Child Health

Free Care (Hospitals Only)



Medicare

Medicaid



Self-Pay


No Charge ( Free, Charity, Special Research or Teaching)

Other Health Insurance Companies



Other

Other



PAYOR (Field 4, CSDR) {payment source}~

K = Key Field



05

05

03

04

06

05

01

05

08

07

02

07

09

09

05

08

CWMS_PROXY

Crosswalk Report

Page 46 of 80


11 Expected/Actual Primary Source of Payment

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

99

BHHF Service (OBHS)

Bureau of Children & Families

Medicare

Medicaid



Self-Pay

Targeted Funds

Charity Services

Private Insurance


HMO

Other (Champus)

Other

Maternal and Child Health

Free Care (Hospitals Only)



Medicare

Medicaid



Self-Pay






Other

Other



Primary Source Of Payment (Payor Field 3, CSDR)

41

K = Key Field



05

05

03

04

06

05

01

05

08

07

02

07

09

09

05

08


CWMS_PROXY

Crosswalk Report

Page 47 of 80


12

12

Detailed Not in Labor Force

Detailed Not in Labor Force

03

05

06

07

08

15

16

17

-

05

06

07

08

15

16

17

Sheltered Work





Not in Labor Force: Inmate



NA = If MDS13 = 01, 02, 03, or 97








Sheltered/non-competitive employment (MH only)

Homemaker

Student

Retired

Disabled

Inmate of Institution ( Prison or Institution - keeps people out of work force)

Disabled

Other

Not Applicable

Homemaker

Student

Retired

Disabled


Disabled

Other

Employment_status (field 35, CC_Core )

Employment_Status (Field 35, CC_Core) .

~

22

K = Key Field



07

01

02

03

04

05

04

06

96

01

02

03

04

05

04

06


CWMS_PROXY

Crosswalk Report

Page 48 of 80


13 Detailed Criminal Justice Referral Categories

-

1

2

3

4

5

6

NA = MDS7 = 01-06 or 97

Federal/State Court

Formal Adjudication Process Other thanFederal State

Probation/Parole

Prison/Jail

DUI

Other Criminal Justice

Not Applicable

State/Federal Court

Other Court ( Not State or Federal)

Probation/Parole

Prison

DUI/DWI

Other Recognized Legal Entity ( Local Law, Corr. Agncy, Youth Ser., Review Board

Criminal Justice Referral (ReferralSource Field 10, fed)

35

K = Key Field



96

01

02

03

06

07

04


CWMS_PROXY

Crosswalk Report

Page 49 of 80


13 Detailed Criminal Justice Referral Categories

03

04

32

34

41

42

45

47

48

48

49

Police


Mental Hygiene

Drug Court


DUI/DWI

Other Court

Prison


Probation

State/Federal Court



Other


Diversionary Program (E.G. TASC)

DUI/DWI


Prison


Probation/Parole

State/Federal Court

CReferralSource (Field 53, CC_Core)~

K = Key Field



04

04

08

02

05

07

02

06

02

03

01

CWMS_PROXY

Crosswalk Report

Page 50 of 80


14

14

15

Marital Status

Marital Status

Days Waiting to Enter Treatment

1

2

3

4

5

6

7

1

2

3

4

5

98

Married

Separated

Widowed

Divorced

Never Married

Single

Unknown

Married

Separated

Widowed

Divorced

Never Married

Not collected

Now Married ( includes those living together as married)

Separated (legally seperated or otherwise absentbecasue of marital discord))

Widowed

Divorced

Never Married - includes clients who are single or whose


Unknown

Now Married ( includes those living together as married)

Separated (legally seperated or otherwise absentbecasue of marital discord))

Widowed

Divorced


Not Collected

CMarital_Status (Field 26, CC_Core)

Marital Status (MaritalStatus Field 39, Mfed)

Time Waiting

~

48

~

K = Key Field



02

03

05

04

01

01

97

02

03

05

04

01

998



02-03-2015

02-03-2015

CWMS_PROXY

Crosswalk Report

Page 51 of 80


15

16

16

Days Waiting to Enter Treatment

Number of Arrests in the 30 Days Prior to Admission

Number of Arrests in the 30 Days Prior to Admission

000-996

997

98

00-96

97

Number of days waiting

Unknown

Not collected

Number of arrests

unknown

Number of Days waiting

Unknown

Not Collected

Number of Arrests

Unknown

Days waiting is derived (ServiceStartDate - Referred Date)

Arrests in 30 days prior to admission

Arrest30da (Field 56, BDS)

~

~

~

K = Key Field



000-996

997

98

00-96

97


CWMS_PROXY

Crosswalk Report

Page 52 of 80


17

17

18

Frequency of Attendance at Self-Help Programs in 30 days prior to Admission

Frequency of Attendance at Self-Help Programs in 30 days prior to Admission

Diagnostic Code Set

1

2

3

4

5

6

97

98

1

2

No attendance in the past month

1-3 times in past month (less than once per week)

4-7 times in past month (about once perweek)

8-15 times in past month (2 or 3 times per week)

16-30 times in past month (4 or more times per week)

Some attendance in past month, but unknown frequency

Unknown

Not collected

DSM-IV

ICD-9

No attendance

less than once a week -1 to 3 times in past 30 days

About once a week - 4-7 times in the pastt 30 days

2 to 3 times per week - 8-15 times in the past 30 days

At least 4 times a week - 16 to 30 times in the past 30 days

Some Attendance in past month, but number of times and frequency is unknown

Unknown

Not Collected

DSM-IV

ICD-9

SelfHelp (Field 54, BDS)

Freq of attendance at self-help prog

Diagnostic Code Set Identifier

~

~

~

K = Key Field



01

02

03

04

05

06

97

98

1

2


CWMS_PROXY

Crosswalk Report

Page 53 of 80


19 Diagnostic Code (ICD-10 Form)

- DSM-IV will be reported7 digit code

Substance Abuse Diagnosis ICD Compatible~

K = Key Field



xxx.xxxx

CWMS_PROXY

Crosswalk Report

Page 54 of 80

West VirginiaMental Health Admissions

1

2

3

MH Diagnostic Code - a,b,c

SMI/SED

School Attendance Status

1

-

-

-

1

2

7

DSM-IV

to be derived from diagnostic code



Yes

No

Unknown

code format

SMI

Not SMI/SED

SED

Yes, client has attended school at any time in the past 3 months

No, client has not attended school at any time in past 3 months

Unknown

Axis1,Axis2 Axis3 {MH Diagnostic code} (Fields 68-70, CC_Core)

SMI/SED Status (Derived from Diagnostic Code - sublist in DMCon)

SchoolAttendance (Field 57, BDS)

MHA1abc

MHA2

MHA3

K = Key Field



XXX.XXXX

1

4

2

1

2

7

CWMS_PROXY

Crosswalk Report

Page 55 of 80


4 Legal Status at Admission to State Hospital

00

6M

AI

AP

CE

DM

DP

EV

EX

IP

IR

NG

NR

PC

PS

TO

VO

Not Reported

6 month Improvement Period

Adjudicated Incompetent

Adult Protective Services

20 Day Court Evaluation

Detainee - Mental Illness

Detainee - Public Intoxication

Pre-sentence Evaluation

Pre-sentence Examination

Indeterminate Period of Commitment

Incompetent to Stand Trial - Restorable

Not Guilty by Reason of Insanity

Incompetent to Stand Trial - Non-Restorable

Probable Cause

Public Safety

Involuntary Criminal

Voluntary

Unknown

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - civil

Involuntary - criminal

Voluntary

Legal Status (from DMCon list)MHA4

K = Key Field



97

03

03

03

03

03

03

03

03

03

03

03

03

03

03

04

01

CWMS_PROXY

Crosswalk Report

Page 56 of 80


5 GAF/CGAS Score

0-100

997

998

GAF/CGAS Score

Unknown

Not Collected

Score

Unknown

Not Collected

Axis5 {GAF/CGAS Score} (Field 75, CC_Core)MHA5

K = Key Field



0-100

997

998

CWMS_PROXY

Crosswalk Report

Page 57 of 80

West VirginiaDischarge/NOMS

1

1

2

2

3

System Transaction at Discharge


State Code at Discharge

State Code at Discharge

Reporting Date at Discharge

A

C

D

A

C

D

-

-

Add

Change

Delete

Add

Change

Delete

WV

WV

Add

Change

Delete

Add

Change

Delete

State abreviation according postal codes

State abreviation according postal codes

System Transaction at discharge


State code

State Code

Reporting date at discharge

~~

~~

~~

~~

~~

K = Key Field



A

C

D

A

C

D

-

-




02-03-2015

02-03-2015

02-03-2015

CWMS_PROXY

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Page 58 of 80


3

4

4

5

5

6

Reporting Date at Discharge

State Provider Identifer at Discharge

State Provider Identifer at Discharge

Client Identifier at Discharge

Client Identifier at Discharge

Co-Dependent/Collateral at Discharge

-

-

-

1

2

MMYYYY

10 characters

11 characters

Yes

No

MMYYYY

1-15 characters

1-15 characters

Yes

No

Month & Year data file submitted

Provider ID

AID {Provider ID} (Field 2, BDS)

Client ID

MCI {Client ID} (Field 47, BDS)

Co-dependent/collateral at discharge (Field 11, Mfed)

~~

~~

~~

~~

~~

~~

K = Key Field



-

-

-

1

2




02-03-2015

02-03-2015

02-03-2015

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Page 59 of 80


6

7

Co-Dependent/Collateral at Discharge

Type of Treatment Service/Treatment Setting at Discharge

1

2

01

02

03

04

05

06

07

08

97

Yes

No

Hospital Inpatient

Free Standing

Hospital

Short Term <= 30 days

Long-Term > 30 days or more

Intensive Outpatient

Outpatient

Detoxification

Unknown

Codependent/collateral

Client

Detoxification, 24-Hour Service, Hospital Inpatient

Detoxification, 24-Hour Service, Free Standing Residential

Rehabilation/Residential - Hospital (other than detoxification)

Rehabilation/Residential - Short Term (30 Daysor Fewer)

Rehabilation/Residential - Long Term (More than 30 Days)

Ambulatory - Intensive -Outpatient

Ambulatory -Non Intensive -Outpatient


State Psychiatric Hospital

Collateral (Field 13, BDS)

Type of service at discharge (Tcode Field 1, Pcode)

~~

~~

K = Key Field



1

2

01

02

03

04

05

06

07

08

72


CWMS_PROXY

Crosswalk Report

Page 60 of 80


7

8

8

9

Type of Treatment Service/Treatment Setting at Discharge

Date of Last Contact or Data Update

Date of Last Contact or Data Update

Date of Discharge

01

02

03

04

05

06

07

08

-

Detoxification, 24-hour service, hospital inpatient

Detoxification, 24-hour service, free-standing residential







MMDDYYYY

Detoxification, 24-Hour Service, Hospital Inpatient

Detoxification, 24-Hour Service, Free Standing Residential

Rehabilation/Residential - Hospital (other than detoxification)

Rehabilation/Residential - Short Term (30 Daysor Fewer)

Rehabilation/Residential - Long Term (More than 30 Days)

Ambulatory - Intensive -Outpatient

Ambulatory -Non Intensive -Outpatient


MMDDYYYY

Tcode (Field 1, PCode)

Date of Last Contact

DOS (Field 1, CSDR)

Date of discharge (ARequestDate) (Field 14, CC_Core)

~~

~~

~~

~~

K = Key Field



01

02

03

04

05

06

07

08

-


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9 Date of Discharge

- MMDDYYYYMMDDYYYY

ARequestDate (Field 14, CC_Core)~~

K = Key Field



-

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10 Reason for Discharge, Transfer, or Discontinuance of Treatment

1

1

1

10

10

12

13

15

19

2

2

20

25

29

3

3

35

4

Routine Discharge (State hospital list - Hospital Discharge Type)

Planned, Services Completed (DCType = 1)

Administrative (from Type of Unplanned Discharge list)

Discharge to jail (Hosp Discharge list)

Member Requested (from Type of Unplanned Discharge list)

Detainee Released by or to court (State Hospital) (Type Unpl list)

Trial Visit (State Hospital list)

Discharge to Homeless Shelter (State Hospital list)

Eloped (fron Hospital Discharge Type list)

Transferred to short term institution (Hosp Discharge list)

Against Medical Advice (from Type of Unplanned Discharge list)

Expired in facility (Hosp Discharge list)

Transferred to group home (Hosp Discharge list)

Expired outside hospital (Hosp Discharge list)

Transferred to SNF (Hosp Discharge list)

Services not initiated by member (no-show when trans) (Type Unp list)

Released to mental health facility (Type Unplanned list)

Lack of participation/missed appts (Type of Unplanned Disch list)

Treatment Completed

Treatment Completed

Dropped out of treatment (lost contact, Left Against Professional Advice

Incarerated or released by or to courts



Treatment Completed

Treatment Completed


Transferred to Another Treatment Program or Facility


Death


Death


Transferred to Trtment Prog or Facil, but did notreport


Ternimated by Facility

DC-Type (Field 85, CC_Code)~~

K = Key Field



01

01

02

05

02

05

01

01

02

04

02

06

04

06

04

14

04

03

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10 Reason for Discharge, Transfer, or Discontinuance of Treatment

4

5

5

6

7

8

9

Transferred to interim care (Hosp Discharge list)

Transferred to another institution (Hosp Discharge list)

Did not follow treatment recommendations (Type Unplanned list)

Deceased (Type of Unplanned Discharge list)

Geographic relocation (Type of Unplanned Discharge list)

Aged out (Type of Unplanned Discharge list)

Corrections/Jail (Type of Unplanned Discharge list)




Death

Other - includes aging out of MH childrens system, extended placement (condition

Other - includes aging out of MH childrens system, extended placement (condition


DC-Type (Field 85, CC_Code)~~

K = Key Field



04

04

03

06

07

07

05

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10

11

12

Reason for Discharge, Transfer, or Discontinuance of Treatment

Provider Identifier at Admission

Client Identifier at Admission

01

02

03

04

05

06

07

08

09

10

Planned, Service completed

Against Medical Advice

Services Not Initiated by Member

Lack of Participation / Missed Appointments

Did Not Follow TX Recommendations

Deceased

Geographic Relocation

Aged Out

Corrections/Jail

Member Requested

Treatment Completed





Death





Reason for discharge (Field 85,86, CC_Core)

Provider ID = AID

Client ID = MCI

~~

--

--

K = Key Field



01

02

02

02

02

06

04

03

05

02


CWMS_PROXY

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Page 65 of 80


13

14

15

Co-Depentent/Collateral at Admission

Client Transaction Type (pulled from admission dataset)

Date of Admission (pulled from admission dataset)

1

2

1

1

1

3

3

8

8

9

9

-

Yes

No

New Admission

New Admission

New Admission

Update/Reassessment of Open Case (inactive)

Update/Reassessment of open case (inactive)


Change in level of care

update

Update

MMDDYYYY

Codependent/collateral

Client

Initial Admission (SA)

Initial Admission (SA)


Transfer or change in service (SA)

Transfer or change in service (MH)





MMDDYYYY

Collateral

Case Status (Field 15, CC_Core)

Service Start Date (Field 10, BDS)

--

--

--

K = Key Field



1

2

A

A

M

T

X

X

T

T

X

-

CWMS_PROXY

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Page 66 of 80


16

17

18

Type of Service at Admission (pulled from admission dataset)

Date of Birth (pulled from admission dataset)

Gender (pulled from admission dataset)

01

02

03

04

05

06

07

08

-

0

1

2

Detoxification, 24-hour services, hospital inpatient

Detoxification, 24-hour services, free-standing residential







MMDDYYYY

Unknown

Male

Female

Detoxification, 24-hour service - Hospital Inpatient

Detoxification , 24 hour service , Free-StandingResidential

Rehabilitation/Residential - Hospital (other thanDetoxification)

Rehabilitation/Residential - Short Term (30 days or fewer)

Rehabilitation/Residential - Long Term (more than 30 days)




MMDDYYYY

Unknown

Male

Female

Tcode (Field 1, Pcode)

CDOB (Field 7, MCI)

Cgender (Field 8, MCI)

--

--

--

K = Key Field



01

02

03

04

05

06

07

08

-

7

1

2

CWMS_PROXY

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19

20

Race (pulled from admission dataset)

Ethnicity (pulled from admission dataset)

0

1

2

3

4

5

6

7

8

10

11

12

13

14

8

9

Unknown

American Indian

Alaska Native

Asian



White

Other

Multi Racial

Mexican

Cuban



Unknown

Not of Hispanic Origins

Puerto Rican

Unknown

American Indian

Alaskan Native (Aleut, Eskimo)

Asian


Native Hawaiian or other Pacific Islander

White

Other single race

Two or more races

Mexican

Cuban

Other Specific Hispanic or Latino


Unknown

Not of Specific Hispanic or Latino Origin

Puerto Rican

CRACE (Field 16, MCI)

Hispanic (Field 17, MCI)

--

--

K = Key Field



97

02

01

13

04

23

05

20

21

02

03

04

06

97

05

01

CWMS_PROXY

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21

21

22

22

Substance Problem At Discharge, (Primary, Secondary, Tertiary)

Substance Problem At Discharge, (Primary, Secondary, Tertiary)

Frequency of Use at Discharge (Primary, Secondary, Tertiary)

Frequency of Use at Discharge (Primary, Secondary, Tertiary)

-

1

2

3

4

5

6

same as MDS14

No use during the last 30 days

1-3 days use during last 30 days



Daily use during last 30 days

Collateral

Same as codes in MDS14

No Use in the Past Month

1-3 Times in the Past Month

1-2 Times in the Past Week

3-6 Times in the Past Week

Daily

Not Applicable

Substance problem at discharge.

Substance problem at discharge..

FreqDrug (Fields 24,25,26 BDS)

Frequency of use at discharge

~~

~~

~~

~~

K = Key Field



-

01

02

03

04

05

96



02-03-2015

02-03-2015

CWMS_PROXY

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Page 69 of 80


23 Living Arrangements at Discharge

01

01

02

02

03

03

04

04

05

05

06

06

06

07

07

08

08

08

Own or Rent non-Subsidized House/Apartment

Own or Rent non-Subsidized House/Apartment









Home of Biological Parents (if Client Age >= 18)

Home of Biological Parents (if Client Age < 18)

Home of Biological Family - House

Adoptive Home (if Client Age < 18)

Adoptive Home (if Client Age >= 18)

Home of Relative (if Client Age >= 18)

Home of Relative (if Client Age < 18)

Home of Relative



















Living Arrangement~~

K = Key Field



03

04

04

03

04

02

04

03

03

04

03

02

04

02

03

03

02

04

CWMS_PROXY

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09

09

10

11

12

13

13

14

14

15

15

16

16

17

17

18

18

19

19

Home of Friend

Home of Friend

Homeless/Homeless Shelter







Regular Foster Home

Regular Foster Home





Personal Care Home

Personal Care Home























K = Key Field



03

04

01

01

01

22

02

22

03

02

32

02

32

32

02

22

02

22

02

CWMS_PROXY

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20

20

21

21

22

23

23

24

24

25

25

26

27

27

28

28

29

30

30





Wilderness Camp

Rest Home

Rest Home

Nursing Home

Nursing Home

ICF-MR Group Home

ICF-MR Group Home

Medical Hospital



Long-Term Care Psychiatric Facility

Long-Term Care Psychiatric Facility
























K = Key Field



02

22

02

22

02

02

52

52

02

02

52

02

52

02

52

02

02

22

02

CWMS_PROXY

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Page 72 of 80


23

23

Living Arrangements at Discharge

Living Arrangements at Discharge

31

31

32

32

33

33

34

34

35

35

36





Individual Support Setting

Individual Support Setting





Independent Psychiatric Facility












Living Arrangement

Living arrangements at discharge

~~

~~

K = Key Field



02

22

22

02

02

22

02

62

02

62

02


CWMS_PROXY

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Page 73 of 80


24

24

Employment at Discharge

Employment at Discharge

02

03

05

06

07

08

09

10

11

12

13

14

15

16

17

Supported Employment

Sheltered Work

Not in Labor Force, Homemaker

Not in Labor Force, Student

Not in Labor Force, Retired

Not in Labor Force, Physically Impaired


Not Employed But looking

Not in Labor Force

Volunteer

Competitive Employment Full Time

Competitive Employment Part Time

Not in Labor Force, Inmate of Institution

Not in Labor Force, Disabled

Not in Labor Force, Other
















Employment Status

Employment at discharge

~~

~~

K = Key Field



02

02

04

04

04

04

04

03

04

04

01

02

04

04

04


CWMS_PROXY

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25

25

26

Detailed Not In Labor Force at Discharge

Detailed Not In Labor Force at Discharge

Number of Arrests in 30 Days Priorto Discharge

-

02

03

05

06

07

08

15

16

17

00-96

97

If DIS24 = 01 or 97

Supported Work

Sheltered Work








Number of arrests

Unknown

Not Applicable



Homemaker

Student

Retired

Disabled


Disabled

Other

Number of Arrests

Unknown

Detailed not in labor force at discharge.

Employment Status (not in Labor Force)

Arrests in Past 30 Days

~~

~~

~~

K = Key Field



96

07

07

01

02

03

04

05

04

06

00-96

97


CWMS_PROXY

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Page 75 of 80


26

27

27

Number of Arrests in 30 Days Priorto Discharge

Frequency of Attendance at Self-Help program in the 30 Days Prior to Discharge

Frequency of Attendance at Self-Help program in the 30 Days Prior to Discharge

57

98

1

2

3

4

5

6

7

Arrest30days

Not Collected

No attendance in the past month

1-3 times in past month (less than once per week)

4-7 times in past month (about once perweek)

8-15 times in past month (2 or 3 times per week)

16-30 times in past month (4 or more times per week)

Some attendance in past month, but Unknown Frequency

Unknown

Number of Arrests

Not Collected

No attendance

Less than once week - 1-3 times in past 30 days

About once a week - 4 to 7 times in past 30 days

2 to 3 times a week - 8 to 15 times in past 30 days

At least 4 times a week - 16 to 30 times in the pqst 30 days

Some Attendance in past month, but number of times and frequency is unknown

Unknown

Number of arrests in 30 days prior to discharge

Self Help

Frequency of attendance at self-help prog 30 days prior

~~

~~

~~

K = Key Field



00-96

98

01

02

03

04

05

06

97



02-03-2015

02-03-2015

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Page 76 of 80


28 Client Transaction Type - Discharge

D

E

U

Discharge (SA client)

Discharge (MH client)

Data Update (MH client)

Discharge (SA)

Discharge (MH)

Update (MH)

Client Transaction Type~~

K = Key Field



D

E

U

CWMS_PROXY

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Page 77 of 80

West VirginiaMental Health Discharge

1

2

3

4

Diagnostic Code Set Identifier

MH Diagnostic Code a,b,c

SMI/SED - Discharge

School Attendance

1

-

1

2

4

7

8

1

2

7

DSM-IV


SMI

SED

Not SMI/SED

Unknown

Not collected

Yes

No

Unknown

DSM-IV

Code type

SMI

SED

Not SMI/SED

Unknown

Not Collected

Yes, client has attended school at any time in the last 3 months

No, client has not attended school at any time in the last 3 months

Unknown

Diagnostic code set Identifier

MH Diagnostic Code (ICD-10 form) 1,2,3

SMI/SED Status at discharge

School attendance

MHD1

MHD2abc

MHD3

MHD4

K = Key Field



1

XXX.XXXX

1

2

4

7

8

1

2

7

CWMS_PROXY

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Page 78 of 80


5 Education/Grade level - MH

01

02

02

03

04

04

05

06

06

07

08

08

08

09

10

10

11

12

Grade 1

Headstart (from Education Status)

Grade 2

Grade 3

Grade 4

Special Education (from Education Status)

Grade 5

Grade 6

GED (from Education Status)

Grade 7

Grade 8

Trade, Vocational or Technical (from Educational Status)

Trade, Vocational or Technical (from Educational Status)

Grade 9

Graduate or Professional School (from Education Status)

Grade 10

Grade 11

Grade 12

Grade 1`

Kindergarten

Grade 2

Grade 3

Grade 4

self-contained special education class

Grade 5

Grade 6

12th grade or GED

Grade 7

Grade 8

Vocational School

Nursery School, Pre-School - Includes Head Start

Grade 9

Graduate or Professional School

Grade 10

Grade 11

12th grade or GED

Grade LevelMHD5

K = Key Field



01

73

02

03

04

74

05

06

12

07

08

71

72

09

70

10

11

12

CWMS_PROXY

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Page 79 of 80


5

6

Education/Grade level - MH

GAF/CGAS score - MH (optional)

13

13

14

15

16

17

18

19-25

26

0-100

997

998

Grade 13

Kindergarten (from Education Status)

Grade 14

Grade 15

Grade 16

Grade 17

Grade 18

Grade 19-25

Grade 26

GAF/CGAS Score

Unknown

Not collected

1st year college

Kindergarten

2nd year college or Associate's Degree

3rd year college

4th year college or Bachelor's Degree

Some Postgraduate Study - Degree not completed

Master's Degree Completed

Post Graduate Study

Post Graduate Study

Score

Unknown

Not Collected

Grade Level

Axis5 (GAF/CGAS Score)

MHD5

MHD6

K = Key Field



13

73

14

15

16

17

18

19-25

19-25

0-100

997

998

REPORT CROSSWALK TO STATE

Crosswalk Management System

End of Report

Documents

Crosswalk Management System - · Crosswalk Management System. ... K = Key Field Item NoTreatment Episode Data Set Item Value State System Data ... Post Graduate Study Grade 2 Nursery