Crosswalk Management System

Transcription

1 Crosswalk Management System Report Filename Run by Report Date REPORT CROSSWALK TO STATE adobe pdf OPS$PCUMMING 13-MAR-13 11:17

2 OPS$PCUMMING Page 2 of 34 Status : VA Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality Media ID : ASSMCA - SeEST - PR - Start Date : 01-DEC-08 End Date : Follow-up : K = Key Field System Puerto Rico 1 System Transaction Type ~ Ti Transaccion A Add A Add C Change C Change D Delete D Delete K 2 State Code ~ Fips State Code - State Postal Abbreviation - PR 3 Reporting Date ~ month and year data file submitted MMYYYY

3 OPS$PCUMMING Page 3 of 34 K = Key Field Minimum Puerto Rico K 1 Provider Identifer ~~ Nombredel Centro/Unidad de Servicio K 2 Client Identifer (Admission) ~~ Numero de Expediente K 3 Co-Dependent/Collateral ++ Not Collected 2 No 2 No Default Value K 4 Client Transaction Type ~~ Etapa Servicio A Admission 1 Admision A Admission 2 Readmision T Transfer/Change in Service 3 Translado K 5 Date of Admission ~~ Date of Admision MMDDYYYY

4 OPS$PCUMMING Page 4 of 34 K = Key Field Minimum Puerto Rico 6 Number of Prior Treatment ~~ Episodios Previos Episodes 0 0 Previous Episodes 1 0 Episodios Previos 1 1 Previous Episodes 2 1 Episodios Previos 2 2 Previous Episodes 3 2 Episodios Previos 3 3 Previous Episodes 4 3 Episodios Previos 4 4 Previous Episodes 5 4 Episodios Previos 5 5 Or More Previous Episodes 6 5 O Mas Episodios Previos 7 Unknown 7 No Aplica 7 Unknown 95 Se Desconoce 8 Not Collected 97 No Se Recopila La Informacion 8 Not Collected 98 Invalido

5 OPS$PCUMMING Page 5 of 34 K = Key Field Minimum Puerto Rico 7 Principal Source of Referral ~~ De Referido 06 Other Community Referral 1 Abogados Privados 06 Other Community Referral 10 Departmento De La Familia 03 Other Health Care Provider 11 Departamento De Salud 06 Other Community Referral 12 Emergencias Sociales 03 Other Health Care Provider 13 Hogar De Rehabilitacion 07 Court/Criminal Justice/DUI/DWI 14 Instituciones Juveniles 06 Other Community Referral 15 Instituciones Provados 06 Other Community Referral 17 Oficina Del Procurador Del Paciente 07 Court/Criminal Justice/DUI/DWI 18 OSAJ 06 Other Community Referral 19 Otras Agencias Gubernamentales 07 Court/Criminal Justice/DUI/DWI 2 Administracion De Correcion 06 Other Community Referral 20 Programas Especiales 03 Other Health Care Provider 21 Reforma De Salud 05 Employer/EAP 22 Alcance Comunitario 02 Alcohol/Drug Abuse Provider 24 Unidades Moviles 01 Individual (includes self-referral)) 25 Voluntarios 97 Unknown 26 Otros 03 Other Health Care Provider 27 Adm Rehabilitacion

6 OPS$PCUMMING Page 6 of 34 K = Key Field Minimum Puerto Rico 7 Principal Source of Referral ~~ De Referido 03 Other Health Care Provider 28 Centro De Salud Mental 03 Other Health Care Provider 29 Hosiptal Psiqiatria Forense 07 Court/Criminal Justice/DUI/DWI 3 Administracion De Tribunales 03 Other Health Care Provider 30 Hosiptal De Psiqiatria 06 Other Community Referral 31 Orhela 06 Other Community Referral 32 Oficina Asuntos De La Juventud 06 Other Community Referral 33 Tereceros Con Interes 03 Other Health Care Provider 34 Hospital Psiqiatria Privado 03 Other Health Care Provider 35 Hospital Privado 03 Other Health Care Provider 36 Programa Privado De Salud Mental 03 Other Health Care Provider 38 Sala De Emergencia 03 Other Health Care Provider 39 Clinico En Practica Privada 06 Other Community Referral 4 Agencias De Orden Ejecutivas 06 Other Community Referral 40 Comunidades 06 Other Community Referral 41 Otras Comunidades De Base Comunitaria 02 Alcohol/Drug Abuse Provider 42 Centro Para TX. De Abuso De Substancias 02 Alcohol/Drug Abuse Provider 5 ASSMCA 04 School (Educational) 6 Calidad De Vida Escolar 06 Other Community Referral 7 Comunidad

7 OPS$PCUMMING Page 7 of 34 K = Key Field Minimum Puerto Rico 7 Principal Source of Referral ~~ De Referido 04 School (Educational) 8 Departamento De Educacion 07 Court/Criminal Justice/DUI/DWI 9 Departemento De Justicia 97 Unknown 95 No Informacion/Desconocido 98 Not Collected 97 No Se Recopila La Informacion 8 Date of Birth ~~ Fecha De Nacimiento MMDDYYYY 9 Sex ~~ De Sexo 1 Male 1 Masculino 2 Female 2 Femenino 7 Unknown 3 Transgenero 7 Unknown 7 Desconocido 8 Not Collected 8 No Se Recopila La Informacion 8 Not Collected 9 Invalido

8 OPS$PCUMMING Page 8 of 34 K = Key Field Minimum Puerto Rico 10 Race ~~ De Raza 01 Alaska Native (Aleut, Eskimo, Indian) 1 Nativo De Alaska 97 Unknown 10 Desconocido 98 Not Collected 11 No Se Recopila La Informacion 02 American Indian ( Other than Alaskan Native) 2 Indio Americano 13 Asian 3 Asiatico 04 Black or African American 4 Negro/AfroAmericano 05 White 5 Blanco 20 Other Single Race 6 Otro 97 Unknown 7 No Informo 23 Native Hawaiians or Other Pacific Islanders 8 Nativo De Hawaii 23 Native Hawaiians or Other Pacific Islanders 9 Nativo De Otra Isla Del Pacifico

9 OPS$PCUMMING Page 9 of 34 K = Key Field Minimum Puerto Rico 11 Ethnicity ~~ De Grupo Etnico 01 Puerto Rican 1 Puertorriqueno 97 Unknown 10 Se Desconoce 98 Not Collected 11 No Se Recoplia La Informacion 98 Not Collected 12 Invalido 02 Mexican 2 Mexicano 03 Cuban 3 Cubano 04 Other Specific Hispanic 4 Dominicano 04 Other Specific Hispanic 5 Hispano De Otra Etnicidad 05 Not of Hispanic Origin 6 No Hispano 05 Not of Hispanic Origin 7 Norteamericano/Anglosajon 97 Unknown 8 No Informo 06 Hispanic - Specific Origin not Specified 9 Hispano (Origen Especifico Deconocido)

10 OPS$PCUMMING Page 10 of 34 K = Key Field Minimum Puerto Rico 12 Education ~~ De Grado Years of School(Highest Grade) ( General 1 1 Grado Years of School(Highest Grade) ( General Grado Years of School(Highest Grade) ( General Grado Years of School(Highest Grade) ( General Grado 00 Less Than One Grade Completed 13 Menos De 1 Ano Completado/Ninguna Years of School(Highest Grade) ( General 16 Curso Vocacional Years of School(Highest Grade) ( General 2 2 Grado Years of School(Highest Grade) ( General 22 Grado Asociado Years of School(Highest Grade) ( General 23 Bachillerato Years of School(Highest Grade) ( General 24 Meastria Years of School(Highest Grade) ( General 25 Doctorado Years of School(Highest Grade) ( General 26 Pre-Escolar Years of School(Highest Grade) ( General 27 Kindergarten Years of School(Highest Grade) ( General 28 Educacion Especial Years of School(Highest Grade) ( General 3 3 Grado Years of School(Highest Grade) ( General 4 4 Grado Years of School(Highest Grade) ( General 5 5 Grado Years of School(Highest Grade) ( General 6 6 Grado

11 OPS$PCUMMING Page 11 of 34 K = Key Field Minimum Puerto Rico 12 Education ~~ De Grado Years of School(Highest Grade) ( General 7 7 Grado Years of School(Highest Grade) ( General 8 8 Grado Years of School(Highest Grade) ( General 80 1 Ano Universidad Years of School(Highest Grade) ( General 81 2 Ano Universidad Years of School(Highest Grade) ( General 82 3 Ano Universidad Years of School(Highest Grade) ( General 83 4 Ano Universidad Years of School(Highest Grade) ( General 84 5 Ano Universidad Years of School(Highest Grade) ( General 85 6 Ano Universidad Years of School(Highest Grade) ( General 86 7 Ano Universidad Years of School(Highest Grade) ( General 87 8 Ano Universidad Years of School(Highest Grade) ( General 9 9 Grado 97 Unknown 95 Desconocide 97 Unknown 96 No Informo 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido 97 Unknown 99 No Aplica

12 OPS$PCUMMING Page 12 of 34 K = Key Field Minimum Puerto Rico 13 Employment Status ~~ De Con Laboral 02 Part Time 1 Empleo Tiempo Parcial 01 Full Time 2 Empleo Toempo Completo 03 Unemployed 3 Desempleado 04 Not in Labor Force 4 Estudia Y Trabja 04 Not in Labor Force 5 No Participa En La Fuerza Laboral 97 Unknown 95 Desconocido 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido

13 OPS$PCUMMING Page 13 of 34 K = Key Field Minimum Puerto Rico 14 Substance Problem Codes ( ~~ De Sustancia Primary-14A,Secondary-14B, Tertiart-14C) 02 Alcohol 1 Alcohol 05 Heroin 10 Heroina (Opiaceos) 05 Heroin 12 Heroina + Cocaina (Speed Ball) 04 Marijuana, Hashish ( includesthc and other 13 Marihuana Cannabis Sativa preperations) 06 Non-Prescription Methadone 14 Metadona 16 Other Non-Barbituate Sedatives or Hypnotics 17 Sedantes 20 Other 18 Tabaco/Cigarrillo 01 None 19 No Usa Actualmente 11 Other Amphetamines 2 Anfetamines 20 Other 22 Otros 20 Other 26 Anestessia De Caballo 05 Heroin 27 Diabillo (Heroina + Marihuana) 15 Barbiturates 3 Barituricos 13 Benzodiazepines 4 Benzodiazepinas 03 Cocaine, Crack 5 Cocaina 03 Cocaine, Crack 8 Crack 09 Other Hallucinogens 9 Ectasy 01 None 95 Desconocido

14 OPS$PCUMMING Page 14 of 34 K = Key Field Minimum Puerto Rico 14 Substance Problem Codes ( ~~ De Sustancia Primary-14A,Secondary-14B, Tertiart-14C) 01 None 96 No Informo 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido 01 None 99 No Aplica 15 Usual Route of Administration ( ~~ De Via Utilizacion Primary-15A, Secondary-15B, Tertiar-15C) 04 Injection (IV or intramuscular) 1 Intravenosa/Inyectado 20 Other 10 Otro 03 Inhalation 2 Nasal/Inhalar 01 Oral 3 Oral 02 Smoking 4 Fumada 97 Unknown 95 Desconocido 96 Not Applicable 96 No Informacion 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido 96 Not Applicable 99 No Aplica

15 OPS$PCUMMING Page 15 of 34 K = Key Field Minimum Puerto Rico 16 Frequency of Use ( Primary-16A, ~~ De Frecuencia Secondary-16B, Tertiary-16C) 01 No use in the past month 1 No Ha Usado En El Mes times in past month Veces Al Mes times per week Veces A La Semana times per week Veces A La Semana 05 Daily 5 Diariamente 97 Unknown 95 Desconocido 96 Not Applicable 96 No Informacion 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido 96 Not Applicable 99 No Aplica 17 Age of First Use (Primary-17A, ~~ Edad De Inico Secondary-17B, Tertiary-17C) 00 Indicates a Newborn with a substance dependecy problem 97 Unknown 98 Not Collected Indicates The Age at First Use 96 Not Applicable

16 OPS$PCUMMING Page 16 of 34 K = Key Field Minimum Puerto Rico K 18 Type of Services ~~ De Abuso Substancias 01 Detoxification - Hospital Inpatient ( Detox, 24 1 Desintoxicacion Droga (Interno) hour Service) 07 Ambulatory - Non-Intensive Outpatient 10 Evaluacion Alcohol 07 Ambulatory - Non-Intensive Outpatient 11 Charlas Socioeducationivas 01 Detoxification - Hospital Inpatient ( Detox, Sala De emergencias hour Service) 96 Not Aplicable - for co-dependent/collateral 12 Desvio 03 Rehabilitation/Residential - Hospital (other than 13 Hospitalizacion detox) 03 Rehabilitation/Residential - Hospital (other than 15 Instituciones Privadas detox) 08 Ambulatory Detoxification 2 Desintoxicacion Droga (Ambulatorio) 01 Detoxification - Hospital Inpatient ( Detox, 24 3 Desintoxicacion Alcohol hour Service) 05 Rehabiliation/Residential - Long-term, ( more 5 Tratamiento Residencial than 30 days) 06 Ambulatory - Intensive Outpatient 6 Tx. Ambulatorio 07 Ambulatory - Non-Intensive Outpatient 7 Ambulatorio 07 Ambulatory - Non-Intensive Outpatient 8 Ambulatorio Con Metadona 07 Ambulatory - Non-Intensive Outpatient 9 Evaluacion Droga

17 OPS$PCUMMING Page 17 of 34 K = Key Field Minimum Puerto Rico 19 Opioid Replacement Therapy ~~ De Metadona (Planned/ Actual)Was -Use of Methadone Planned/Actual 1 Yes 1 Si 2 No 2 No 7 Unknown 3 No Aplica 7 Unknown 4 Desconocido 8 Not Collected 5 No Se Recopila La Informacion 8 Not Collected 6 Invalido

18 OPS$PCUMMING Page 18 of 34 K = Key Field Optional Puerto Rico 1 Detail Drug Code, Primary ~~ De Sustancia 0201 Alcohol 1 Alcohol 0501 Heroine 10 Heroina (Opiaceos) 0401 Marijuana/Hashish 13 Marihuana 0601 Non - Prescription Methadone 14 Metadona 1604 Other Non-Barbiturate Sedatives 17 Sedantes 1101 Amphetamine 2 Anfetamines 2002 Other Drugs 22 Otros 1705 Anesthetics 26 Anestessia De Caballo 1509 Other Barbiturate Sedatives 3 Barituricos 1308 Other Benzodiazepine 4 Benzodiazepinas 0302 Other Cocaine 5 Cocaina 0301 Crack 8 Crack 1103 Methyleneioxymethampetamine (MDMA, 9 Ectasy Ecstacy 9998 Not Collected 97 No Se Recopila La Informacion 4 DSM Diagnosis * De Dsmiv XXX.XX DSM/ICD codes xxx.xx codes on spreadsheet

19 OPS$PCUMMING Page 19 of 34 K = Key Field Optional Puerto Rico 5 Psychiatric Problem in Addition to Alcohol or Drug Problem * Ademas Del Problema de abuso substancias tiene algun problema de salud mental 1 Yes 1 Si 2 No 2 No 7 Unknown 95 Se desconoce 6 Pregnant at Time of Admission * De Femina 1 Yes 1 Embarazadas Sin Hijos Dependientes 1 Yes 2 Embarazadas Con Hijos Dependientes 2 No 3 Femenina Sin Hijos Dependientes 2 No 4 Femenina Con Hijos Dependientes 7 Veteran Status * De Veterano 1 Yes 1 Si 2 No 2 No 7 Unknown 3 No Aplica 7 Unknown 7 Desconocide 8 Not Collected 8 No Se Recopila La Informacion 8 Not Collected 9 Invalido

20 OPS$PCUMMING Page 20 of 34 K = Key Field Optional Puerto Rico 8 Living Arrangements * De Residencia 03 Independent Living 1 Propia 02 Dependent Living 10 Hogar Sustituto 01 Homeless 11 Sin Hogar 02 Dependent Living 13 Hogar Transicional 02 Dependent Living 14 Institucion Psquiatrica Hospitalaria 03 Independent Living 2 Alquilada 03 Independent Living 3 Familiares 03 Independent Living 4 Amigos 02 Dependent Living 5 Instituciones Residentciales 02 Dependent Living 6 Hogares Grupales, Orfanato 02 Dependent Living 7 Institucion Correccional 02 Dependent Living 9 Hogares De Crianza 97 Unknown 95 Se Desconoce 98 Not Collected 97 No Se Reopila La Informacion 98 Not Collected 98 Invalido

21 OPS$PCUMMING Page 21 of 34 K = Key Field Optional Puerto Rico 9 Source of Income/Support * De Fuetelngreso 01 Wages/Salary 1 Salario/Jornal 04 Disability 11 Incapacitado 21 None 12 Ninguno 03 Retirement/Pension 2 Pension/Seguro Social 02 Public Assistance 3 Programa Asistencia Nutricional 02 Public Assistance 4 Programa Asistencia Economica 03 Retirement/Pension 5 Pension Alimenticia 03 Retirement/Pension 6 Pension De Veteranos 20 Other 7 Ayuda De Familiares 20 Other 8 Otras 97 Unknown 95 Se Deconoce 97 Unknown 96 No Informo 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido

22 OPS$PCUMMING Page 22 of 34 K = Key Field Optional Puerto Rico 10 Health Insurance * De Seguro Salud 21 None 1 No Tiene 01 Private Insurance (other than BCBS or HMO) 2 Plan Privado 04 Medicaid 3 Reforma/Medicaid 03 Medicare 4 Medicare 97 Unknown 95 Se Desconoce 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido

23 OPS$PCUMMING Page 23 of 34 K = Key Field Optional Puerto Rico 11 Expected/Actual Primary Source of * De Pago Payment 01 Self-Pay 1 Pago Directo 06 Worker's Compensation 11 Fondo Del Seguro Del Estado 07 Other Health Insurance Companies 2 Plan Privado 03 Medicare 3 Medicare 04 Medicaid 4 Medicaid 05 Other Government Payments 5 Reforma 08 No Charge ( Free, Charity, Special Research or 6 No Se Cobra Teaching) 09 Other 7 Otra Fuenta De Pago 97 Unknown 95 Se Desconoce 98 Not Collected 97 No Se Recoplia La Informacion 98 Not Collected 98 Invalido

24 OPS$PCUMMING Page 24 of 34 K = Key Field Optional Puerto Rico 12 Detailed Not in Labor Force * De No Fuerza Laboral 01 Homemaker 1 Ama De Casa 03 Retired 2 Retirado 04 Disabled 3 Incapacitado 02 Student 4 Estudiante 96 Not Applicable 5 Realiza Trabajo Voluntario o No Remunerado 06 Other 7 Otros 05 Inmate of Institution ( Prison or Institution - 9 Encarcelado keeps people out of work force) 97 Unknown 95 Desconocido 97 Unknown 96 No Informo 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido 96 Not Applicable 99 No Aplica

25 OPS$PCUMMING Page 25 of 34 K = Key Field Optional Puerto Rico 13 Detailed Criminal Justice Referral * De Estado Legal Categories 05 Diversionary Program (E.G. TASC) 1 Drug Court (247.1) 08 Other 10 Ley Other 11 Regla Other 12 Regla Probation/Parole 13 Probatoria 05 Diversionary Program (E.G. TASC) 14 TASC 05 Diversionary Program (E.G. TASC) 15 TASC Juvenil 08 Other 16 Otros 01 State/Federal Court 19 Ley Diversionary Program (E.G. TASC) 2 Drug Court (404) 96 Not Applicable 21 No Intervenido Por Justicia 01 State/Federal Court 22 Ley State/Federal Court 3 Ley 22 Alcohol 01 State/Federal Court 4 Ley State/Federal Court 5 Ley State/Federal Court 6 Ley State/Federal Court 7 Ley 78 (Empleados Publicos) 01 State/Federal Court 8 Ley 659 (Sector Privado)

26 OPS$PCUMMING Page 26 of 34 K = Key Field Optional Puerto Rico 13 Detailed Criminal Justice Referral * De Estado Legal Categories 01 State/Federal Court 9 Ley Not Applicable 96 No Informo 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido 97 Unknown 99 No Aplica 96 Not Applicable 99 No Aplica 14 Marital Status * De Estado Marital 01 Never Married 1 Nunca Casado 02 Now Married ( includes those living together as 2 Casado(a) married) 04 Divorced 3 Divorciado (a) 03 Separated (legally seperated or otherwise absent 4 Separado(a) becasue of marital discord)) 05 Widowed 5 Viudo (a) 02 Now Married ( includes those living together as 6 Union Consensual married) 97 Unknown 95 Desconocido 97 Unknown 96 No Informo 98 Not Collected 97 No Se Recopila La Informacion 98 Not Collected 98 Invalido

27 OPS$PCUMMING Page 27 of 34 K = Key Field Optional Puerto Rico 15 Days Waiting to Enter Treatment * Dias de espera para entrar a tratamiento 998 Not Collected 997 Unknown Days 16 Number of Arrests in the 30 Days * Numero de arrestos durante los pasados 30 dias o durante el tratamiento si duro Prior to Admission Number of Arrests 1 Si 97 Unknown 2 No 17 Frequency of Attendance at Self- * Ha participado en reuniones grupos de apoyo, auto-ayuda, religiosos o ha buscado Help Programs in 30 days prior to Admission times in past month (less than once per 1 Si week) 01 No Attendance in past month 2 No times in past month ( about once per week) times in past month (2 or 3 times per week) times in past month ( 4 or more times per week) 97 Unknown 98 Not Collected 06 Some Attendance in past month, but frequency unknown

28 OPS$PCUMMING Page 28 of 34 K = Key Field Discharge/NOMS Puerto Rico 1 System Transaction at Discharge ~ Ti Transaccion 2 State Code at Discharge ~ Fips State Code - State abreviation according postal codes - PR 3 Reporting Date at Discharge ~ month and year data file submitted MMYYYY 4 Provider Identifer at Discharge ~~ Nombredel Centro/Unidad de Servicio 5 Client Identifier at Discharge ~~ Numero de Expediente 6 Co-Dependent/Collateral at ++ Not Collected Discharge

29 OPS$PCUMMING Page 29 of 34 K = Key Field Discharge/NOMS Puerto Rico 7 Type of Service at Discharge ~~ De Abuso Substancias 01 Detoxification, 24-Hour Service, Hospital 1 Desintoxicacion Droga (Interno) Inpatient 07 Ambulatory -Non Intensive -Outpatient 10 Evaluacion Alcohol 07 Ambulatory -Non Intensive -Outpatient 11 Charlas Socioeducationivas 01 Detoxification, 24-Hour Service, Hospital 12 Sala De emergencias Inpatient 03 Rehabilation/Residential - Hospital 13 Hospitalizacion 03 Rehabilation/Residential - Hospital 15 Instituciones Privadas 08 Ambulatory Detoxification 2 Desintoxicacion Droga (Ambulatorio) 01 Detoxification, 24-Hour Service, Hospital 3 Desintoxicacion Alcohol Inpatient 05 Rehabilation/Residential - Long Term (More 5 Tratamiento Residencial than 30 Days) 06 Ambulatory - Intensive -Outpatient 6 Tx. Ambulatorio 07 Ambulatory -Non Intensive -Outpatient 7 Ambulatorio 07 Ambulatory -Non Intensive -Outpatient 8 Ambulatorio Con Metadona 07 Ambulatory -Non Intensive -Outpatient 9 Evaluacion Droga 8 Date of Last Contact * Fecha De Ulimo Contacto MMDDYYYY 9 Date of Discharge * Fecha De Alta MMDDYYYY

30 OPS$PCUMMING Page 30 of 34 K = Key Field Discharge/NOMS Puerto Rico 10 Reason for Discharge, Transfer, or * De Alta Discontinuance of Treatment 01 Treatment Completed 1 Completo tratamiento/servicio 02 Left Against Professional Advice 2 Abandono El Servicio 04 Transferred to Another Substance Abuse 3 Translado A Otro Centro Treatment Program or Facility 06 Death 4 Muerte 05 Incarerated 5 Encarcelato 07 Other 6 Otro 03 Ternimated by Facility 8 Alta Administrativa 08 Unknown 95 Se Desconoce 11 Provider Identifier at Admission ~~ Nombredel Centro/Unidad de Servicio - Comes from admission file 12 Client Identifier at Admission ~~ Numero de Expediente - Comes from admission file 13 Co-Depentent/Collateral at ++ Not Collected Admission - Comes from admission file

31 OPS$PCUMMING Page 31 of 34 K = Key Field Discharge/NOMS Puerto Rico 14 Client Transaction Type. ~~ Etapa Servicio - Comes from admission file 15 Date of Admission. ~~ Date of Admision - Comes from admission file 16 Type of Service at Admission ~~ De Abuso Substancias - Comes from admission file 17 Date of Birth. ~~ Fecha De Nacimiento - Comes from admission file 18 Sex. ~~ De Sexo - Comes from admission file 19 Race. ~~ De Raza - Comes from admission file 20 Ethnicity. ~~ De Grupo Etnico - Comes from admission file

32 OPS$PCUMMING Page 32 of 34 K = Key Field Discharge/NOMS Puerto Rico 21 Substance Problem At Discharge, ~~ De Sustancia (Primary, Secondary, Tertiary) - Same as codes in MDS14 22 Frequency of Use at Discharge ~~ De Frecuencia (Primary, Secondary, Tertiary) - Sames as coodes in MDS16 23 Living Arrangements at Discharge * De Residencia - Codes same as in SUDS8 24 Employment at Discharge ~~ De Con Laboral - Codes same as MDS Detailed Not In Labor Force at * De No Fuerza Laboral Discharge - Codes same as SuDS 12

33 OPS$PCUMMING Page 33 of 34 K = Key Field Discharge/NOMS Puerto Rico 26 Number of Arrests in 30 Days Prior * Numero de arrestos durante los pasados 30 dias o durante el tratamiento si duro to Discharge Number of Arrests 1 Si 998 Not Collected 2 No 997 Unknown 27 Frequency of Attendance at Self- * Ha participado en reuniones grupos de apoyo, auto-ayuda, religiosos o ha buscado Help program in the 30 Days Prior to Discharge times in the past month ( less than once per 1 Si week) 01 No Attendance in past month 2 No times in the past month ( about once per week) times in the past month (2-3 times per week) times in past month (4 or more times per week) 06 Some attendance, but frequency unknown 97 Unknown 98 Not Collected

34 Crosswalk Management System REPORT CROSSWALK TO STATE End of Report