Health Indicators Template

Transcription

1 Mental Health Information System (MHIS) Manual Page Posted: 06/02/14 Page Reviewed: 5/26/2015 Page Updated: 5/14/ Health Indicators Template VARIABLE NAME: HEALTH INDICATOR OPTIONAL DATA DESCRIPTION: Identifies that the provider is completing the Health Indicator fields. o 1 Yes GUIDELINES: ACT providers enter 1, while other provider types enter 1 for Yes otherwise leave blank FIELD NUMBER: T1 FIELD TYPE: Text VARIABLE NAME: GENERAL PHYSICAL EXAM DATE DESCRIPTION: Identifies the most recent date the General Physical exam was completed. GUIDELINES: If a Physical Exam date does not exist or is over two years old, then enter 01/01/1900 as the date. FIELD NUMBER: T2 VARIABLE NAME: HEIGHT/WEIGHT DATE DESCRIPTION: Identifies the most recent date the Height/Weight was measured. GUIDELINES: Report the date client s height/weight was last measured. If client s height/weight was not measured, then enter 01/01/1900. FIELD NUMBER: T3 VARIABLE NAME: HEIGHT DESCRIPTION: Specifies the client s Height in inches (rounded up). o GUIDELINES: Report the client s Height in inches.

2 FIELD NUMBER: T4 X VARIABLE NAME: WEIGHT DESCRIPTION: Specifies the client s Weight in pounds (rounded up). o GUIDELINES: Report the client s Weight in pounds-field must be updated when measure changes. FIELD NUMBER: T5 X VARIABLE NAME: BLOOD PRESSURE DATE DESCRIPTION: Identifies the most recent date the client s Blood Pressure was measured. GUIDELINES: Enter the most recent date the client s blood pressure was measured. If it was not measured, then enter 01/01/1900. FIELD NUMBER: T6 VARIABLE NAME: SYSTOLIC BLOOD PRESSURE READING DESCRIPTION: Specifies the client s Systolic Blood Pressure reading. o GUIDELINES: Report the client s Systolic Blood Pressure reading FIELD NUMBER: T7 FIELD LENGTH: 3 XX VARIABLE NAME: DIASTOLIC BLOOD PRESSURE READING DESCRIPTION: Specifies the client s Diastolic Blood Pressure reading o GUIDELINES: Report the client s Diastolic Blood Pressure reading FIELD NUMBER: T8 FIELD LENGTH: 3

3 XX VARIABLE NAME: LDL DATE DESCRIPTION: Identifies the most recent date the client s LDL was measured. GUIDELINES: Most recent date the client s LDL was measured. If it was not measured, then enter 01/01/1900. FIELD NUMBER: T9 VARIABLE NAME: LDL LEVEL DESCRIPTION: Specifies the client s LDL level o 1 Less than or equal to 129 o 2 Greater than or equal to 130 o 8 Not Tested GUIDELINES: Select the range that represents the client s LDL level. FIELD NUMBER: T10 VARIABLE NAME: BLOOD SUGAR LEVEL DATE DESCRIPTION: Identifies the most recent date the client s blood sugar level was measured. GUIDELINES: Most recent date the client s blood sugar level was measured. If it was not measured, then enter 01/01/1900. FIELD NUMBER: T11 VARIABLE NAME: BLOOD SUGAR LEVEL DESCRIPTION: Specifies the client s Blood Sugar Level. o 1 Non diabetic: fasting less than or equal to 125 o 2 Non diabetic: fasting greater than or equal to 126 o 3 Hemoglobin A1c less than 8 o 4 Hemoglobin A1c greater than or equal to 8 o 8 Not Tested

4 GUIDELINES: Select the range the represents the client s Blood Sugar Level FIELD NUMBER: T12 VARIABLE NAME: TOBACCO USE DATE DESCRIPTION: Identifies the most recent date the client used tobacco during the previous 30 days. GUIDELINES: Most recent date client used tobacco during the previous 30 days. If date is not available, then enter 01/01/1900. FIELD NUMBER: T13 VARIABLE NAME: TOBACCO USE DESCRIPTION: Specifies the client s tobacco use in the previous 30 days. o 1 No tobacco use o 2 Ongoing tobacco use GUIDELINES: Select the client s tobacco usage. FIELD NUMBER: T14 VARIABLE NAME: ALCOHOL USE DATE DESCRIPTION: Identifies the most recent date the client used alcohol in the previous 30 days. GUIDELINES: Most recent date client used alcohol during the previous 30 days. If date is not available, then enter 01/01/1900. FIELD NUMBER: T15 VARIABLE NAME: HOW MANY DAYS PER WEEK DID THE CLIENT DRINK: PREVIOUS 30 DAYS DESCRIPTION: Specifies the average number of days per week the client drank an alcoholic beverage in the previous 30 days. o 0-7

5 GUIDELINES: Enter the number that represents the client s alcohol use per week. FIELD NUMBER: T16 VARIABLE NAME: HOW MANY DRINKS PER DAY DID THE CLIENT DRINK: PREVIOUS 30 DAYS DESCRIPTION: Specifies the average number of drinks per day the client drank an alcoholic beverage in the previous 30 days o 0-25 GUIDELINES: Enter the number that represents the client s alcohol use per day. FIELD NUMBER: T17 X VARIABLE NAME: TOTAL NUMBER OF ALCOHOL DRINKS ON A GIVEN OCCASION: PREVIOUS 30 DAYS DESCRIPTION: Specifies the maximum number of alcohol drinks on a given occasion in the previous 30 days o 0-25 GUIDELINES: Enter the number that represents the client s alcohol use per day. FIELD NUMBER: T18 X