crosswalk management system - dasis home page · k = key field item notreatment episode data set...

REPORT CROSSWALK TO STATE

23-DEC-16 01:29Report Date :

Run by :

Report :

CWMS_PROXY

Filename :

Crosswalk Management System

CWMS_PROXY

Crosswalk Report

of 71

Status : FN

Start Date : 01-JUL-92End Date :

Follow-up :

Media ID : CIS - AZ

ArizonaSystem

K

1

1

2

3

System Transaction Type

System Transaction Type

State Code

Reporting Date

1

2

1

2

3

-

Trans Code EOC Start

Trans Code EOC Assessment Update

Add

Change

Delete

AZ

Add

Add

Add

Change

Delete

State Postal Abbreviation

System Transaction Type Added to Each Record


FIPS Code Added to Each Record

Month and Year of Submission Added to Each Record

-

-

AZ

-

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

Arizona's Treatment Episode Data SetVersion : 1

A

A

A

C

D

-

No longer effective as of: 03-31-2007

mmyyyy

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

K

K

K

K

K

K

K

K

1

1

2

3

4

4

5

5

State Provider Identifer

State Provider Identifer

Client Identifer (Admission)

Co-Dependent/Collateral

Client Transaction Type


Date of Admission

Date of Admission

2

A

A

No

Admission

Admission

No

Admission (SA)

Admission (SA)

ProviderID/Site Id

Contractor/Subcontractor/Facility

Client Identifier

Co-Dependent/Collateral Data - Not Collected


Type of Intake

Date of Intake

EOC Start Date

-

2

3

-

-

8

4

-

K = Key Field



2

A

A

No longer effective as of:



09-01-1998

03-31-2007

09-01-1998

Provider_ID +2 digits (01-99)

10 Characters and Unique

MMDDYYYY

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

6

6

Prior Treatment Episodes

Prior Treatment Episodes

0

1

2

3

4

5

8

0 Previous episodes

1 Previous episodes

2 Previous episodes

3 Previous episodes

4 Previous episodes

5 or more Previous episodes

Not collected

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

Not Collected

System calculated by number of prior admissions

Not Collected

-

-

K = Key Field



0

1

2

3

4

5

8


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

7 Principal Source of Referral

01

03

19

35

36

37

38

39

40

41

97

self/family/friend

other BH provider

Federal agency

AHCCCS or PCP

CPS 24 hr urgent care

community agency

ADES

ADE

Criminal justice

Other

Blank

Individual (includes self-referral))

Other Health Care Provider

Other Community Referral





School (Educational)

Court/Criminal Justice/DUI/DWI

Unknown

Unknown

Principal source of referral-

K = Key Field



01

03

06

06

06

06

06

04

07

97

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

7

8

8

Principal Source of Referral

Date of Birth

Date of Birth

01

03

05

19

35

36

37

38

39

40

41

97

self/family/friend

other BH provider

RBHA Customer Service

Federal agency

AHCCCS or PCP

CPS 24 hr urgent care

community agency

ADES

ADE

Criminal justice

Other

Blank

Individual (includes self-referral))

Other Health Care Provider







School (Educational)

Court/Criminal Justice/DUI/DWI

Unknown

Unknown

Principal source of referral

Date Of Birth

Date of Birth

-

13

09

K = Key Field



01

03

06

06

06

06

06

06

04

07

97

97


MMDDYYYY

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

9

9

10

Gender

Gender

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

1

2

7

F

M

97

All N

Y

Y

Y

Y

Y

Y

Male

Female

Blank

Female

Male

Blank

All race categories checked no

American Indian/Alaskan Native

Native Hawaiian

White

More than one race checked yes

Asian

Black

Male

Female

Unknown

Female

Male

Unknown

Unknown

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

Native Hawaiians or Other Pacific Islanders

White

Two or More Races

Asian

Black or African American

Sex.

Sex (M/F)

Race.

-

14

-

K = Key Field



1

2

7

2

1

97

97

02

23

05

21

13

04


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimumK = Key Field



CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

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

01

02

04

05

06

07

08

CH

CO

CR

FM

GR

HA

HO

HU

KP

MY

White

Black/African American

Asian


Other

Unknown

Native Hawaiian/Pacific

Ak Chin

Cocopah

Colorado River Indian Tribe

Fort Mohave

Gila River

Havasupai

Hopi

Hualapai

Kaibib Paiute

Fort McDowell

White


Asian or Pacific Islander use only if not collecting codes separately


Other Single Race

Unknown

Asian or Pacific Islander use only if not collecting codes separately











Race15

K = Key Field



05

04

03

02

20

97

03

02

02

02

02

02

02

02

02

02

02

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

10

11

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

Hispanic or Latino Origin ( Ethnicity)

NA

PY

QU

SC

SR

TA

TO

WM

YA

YP

97

N

Y

Navajo Nation

Pascua Yaqui

Quechuan

San Carlos Apache

Salt River Pima

Tonto Apache

Tohono O'adham

White Mountain

Camp Verde Apache

Yavapai Prescott Apache

Blank

Not Hispanic

Hispanic











Asian

Native Hawaiians or Other Pacific Islanders

Unknown

Not of Hispanic or Latino Origin

Hispanic or Latino - Specific Origin not Specified

Race

Ethnicity.

15

-

K = Key Field



02

02

02

02

02

02

02

02

02

02

13

23

97

05

06


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

11 Hispanic or Latino Origin ( Ethnicity)

01

02

Hispanic or Latino

Not Hispanic or Latino

Other Specific Hispanic

Not of Hispanic or Latino Origin

Ethnicity,16

K = Key Field



04

05


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

12 Education

00

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

Less than one year

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Less Than One Grade Completed

Master's Degree Completed

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

12th Grade or GED

Grade 1

Grade 2

Some Post-Graduate Study - Degree not completed

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

1st year of College/Iniversity (Freshman)

2nd year of College/Iniversity (Sophomore)

Education Level Completed-

K = Key Field



00

18

03

04

05

06

07

08

09

10

11

12

01

02

17

16

13

14

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

12 Education

01-25

01-25

26

27

28

29

30

31

32

97

A

B

C

Years completed

Years completed

High School Graduate or GED

Some College, No Degree

Vocational/Technical School

Associates Degree

Bachelor's Degree

Master's Degree

Doctoral or Post Graduate

Blank

Early intervention

Early Childhood Education

Kindergarten

3rd year of College/Iniversity (Junior)

Post Graduate Study

12th Grade or GED






Post Graduate Study

Unknown




Education Level Completed-

K = Key Field



15

19-25

12

13

14

14

16

18

19-25

97

00

00

00

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

12 Education

00

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

01-25

Less than one year

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed

Years completed


Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

12th Grade or GED



3rd year of College/Iniversity (Junior)


Some Post-Graduate Study - Degree not completed


Post Graduate Study

Formal Schooling Level-

K = Key Field



00

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

19-25

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

12 Education

01-25

01-25

97

Years completed

Years completed

Blank

Grade 1

Grade 2

Unknown

Formal Schooling Level-

K = Key Field



01

02

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

13 Employment Status

01

02

03

04

08

14

17

18

19

20

21

22

23

97

99

Full time - no support

Part time - no support

Full time - with support

Part time - with support

Unemployed

Volunteer

Unpaid rehab activity

retired/homemaker/student

Homemaker

Student

Retired

Disabled

Inmate Institution

blank

unknown

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

Part Time - works less tahn 35 hours per week



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

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








Unknown

Unknown

Employment status-

K = Key Field



01

02

01

02

03

04

04

04

04

04

04

04

04

97

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

13 Employment Status

01

02

03

04

08

14

17

18

19

20

21

22

23

24

25

26

27

97





Unemployed

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution

Competitively Employed full time

Competitively employed part-time

Work adjusted training

Transitional employment placement

blank


















Unknown

Employment status-

K = Key Field



01

02

01

02

03

04

04

04

04

04

04

04

04

01

02

04

02

97

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

13

14

Employment Status

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

99

0001

0201

0302

0401

0501

0706

0902

1001

1201

1308

1605

1703

2002

97

unknown

none past 30 days

Alcohol

Cocaine/crack

Marijuana/Hashish

Heroin/morphine

Other Opiates and Synthetics

Hallucingens

Methamphetamine/speed

Other stimulants

Benzodiazepines

Other sedatives/tranquilzers

Inhalants

Other drugs

Blank

Unknown

None

Alcohol

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

Heroin


Hallucinogens

Methamphetamine

Other Stimulants

Benzodiazepines

Other Non-Barbituate Sedatives or Hypnotics

Inhalants

Other

Unknown

Employment status

SA Type ( Primary and Secondary only - added Tertiary - 4/07)

-

-

K = Key Field



97

01

02

03

04

05

07

09

10

12

13

16

17

20

97

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

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

-

0001

0201

0302

0401

0501

0706

0902

1001

1201

1308

1605

1703

2002

97

Tertiary substance field (future)

none past 30 days

Alcohol

Cocaine/crack

Marijuana/Hashish

Heroin/morphine


Hallucingens


Other stimulants

Benzodiazepines


Inhalants

Other drugs

Blank

Not Collected

None

Alcohol

Cocaine, Crack

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)

Heroin


Hallucinogens

Methamphetamine

Other Stimulants

Benzodiazepines

Other Non-Barbituate Sedatives or Hypnotics

Inhalants

Other

Unknown


-

K = Key Field



98

01

02

03

04

05

07

09

10

12

13

16

17

20

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

15

15

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

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

1

2

3

4

6

96

97

1

2

3

4

6

97

Oral

Smoking

Inhalation

Injection

No Use

Substance problem = none

Blank

Oral

Smoking

Inhalation

Injection

No Use

Blank

Oral

Smoking

Inhalation

Injection (IV or intramuscular, intradermal or subcutaneous)

Not Applicable

Not Applicable

Unknown

Oral

Smoking

Inhalation

Injection (IV or intramuscular, intradermal or subcutaneous)

Not Applicable

Unknown

Usual route of administration

Usual route of administration

-

-

K = Key Field



01

02

03

04

96

96

97

01

02

03

04

96

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

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

1

2

3

4

5

97

No Use in The Past Month

1-3 Times in Past Month

1-2 Times in Past Week


1 or more per day

Blank

No use in the past month

1-3 times in past month

1-2 times per week

3-6 times per week

Daily

Unknown

Frequency of Use-

K = Key Field



01

02

03

04

05

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

16

17

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

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

1

2

3

4

5

6

7

8

96

97

00

01-95

96

96-99

97





1 or more per day

No use during the past 3 months




Blank

Under Age 1

Age


Age, use TEDS '95'

Blank



1-2 times per week

3-6 times per week

Daily




Not Applicable

Unknown

Newborn with a substance dependecy problem

Age at First Use, in years

Not Applicable


Unknown

Frequency of Use

Age of first use

-

-

K = Key Field



01

02

03

04

05

01

01

01

96

97

00

01-95

96

01-95

97

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

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

-

00

01-95

97

Tertiary Field (future)

Under Age 1

Age

Blank

Not Collected

Newborn with a substance dependecy problem


Unknown

Age of first use-

K = Key Field



98

00

01-95

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

K 18 Type of Services

83840

A01

A02

A03

A04

A05

C10

C11

C12

C13

D14

D15

D16

D17

D19

D21

F26

F27

Pharmacological Therapy

Treatment - Individual counseling

Treatment - Group counseling

Treatment - family counseling

Treatment - consult, assess, specialized

Treatment other professional

Medical-Medication service

Medical - Lab, radiology, medical imaging

Medical - Medical management

Medical - Electro-convulsive therapy

Case Management

Personal assistance

Family Support

Peer support

Respite Care

Interpreter services

Inpatient hospital psychiatric

Hospital Detox

Ambulatory - Non-Intensive Outpatient
















Rehabilitation/Residential - Hospital (other thandetox)

Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Encounter procedure code-

K = Key Field



07

07

07

07

07

07

07

07

07

07

07

07

07

07

07

07

03

01

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum


F28

F29

F30

F31

H0018

H0019

H0020

H0043

H36

H37

H38

Inpatint sub acute psychiatric

Inpatient sub acute detox

Inpatient TRC psychiatric

Inpatient RTC detox

Short Term residential

Long Term residential


Supported Housing

BH Day program - supervised

BH Day program - therapeutic

BH Day program - medical


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



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

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



Ambulatory - Intensive Outpatient




K = Key Field



03

02

03

02

04

05

07

05

06

06

06

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum


A01

A02

A03

A04

A05

C11

C12

C13

D14

D15

D16

D17

D19

D21

F26

F27

F28

F29









Case Management

Personal assistance

Family Support

Peer support

Respite Care



Hospital Detox


















Detoxification - Hospital Inpatient ( Detox, 24 hour Service)




K = Key Field



07

07

07

07

07

07

07

07

07

07

07

07

07

07

03

01

03

02

CWMS_PROXY

Crosswalk Report

of 71

ArizonaMinimum

K 18

19

19

Type of Services

Medication-Assisted Opioid Therapy

Medication-Assisted Opioid Therapy

F30

F31

H0018

H0019

H0043

H36

H37

H38

2

83840

H0020

8


Inpatient RTC detox



Supported Housing




Blank



Not collected



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






No

Yes

Yes

Not Collected

Encounter procedure code


Not Collected

-

-

-

K = Key Field



03

02

04

05

05

06

06

06

2

1

1

8



03-31-2011

03-31-2011

CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

1 Detail Drug Code, Primary

9998 9998Not Collected

Not Collected-

K = Key Field



9998

CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

1 Detail Drug Code, Primary

0201

0302

0401

0501

0601

0700

0801

0902

1001

1201

1308

1504

1605

1703

2002

Alcohol

Cocaine

Marijuana

Heroin/Morphine

Methadone

Other Narcotics

PCP

Other Hallucinogens

Methamphetamine

Other Stimulants

Benzodiazepines

Barbituates

Other Sedatives

Inhalants

Other Drugs

Alcohol

Other Cocaine

Marijuana/Hashish,THC and any other cannabis sativa preparation

Heroine/Morphine

Methadone

Other Narcotic Analgesics

PCP or PCP Combinations

DMT, mescaline, peyote,STD and Other Hallucinogens

Methamphetamine/Speed

Other Stimulants

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

Other non-benzodiazepineTranquilizer

Other Non-Barbiturate Sedatives

Gasoline,glue, and other inapproriately inhaled products

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

Ketamine ( Special K)

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

Fluitrazepram (Rohypnol)

Substance Use25

K = Key Field



0201

0302

0401

0501

0601

0706

0801

0902

1001

1201

1308

1403

1604

1703

2002

1608

1607

1606

CWMS_PROXY

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ArizonaSupplemental

1

2

2

3

3

4

4

Detail Drug Code, Primary

Detail Drug Code, Secondary

Detail Drug Code, Secondary

Detail Drug Code, Tertiary

Detail Drug Code, Tertiary

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

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

999.97

xxx.xx

Blank

DX code

Clonazepam (Klonopin, Rivotril)

Methyleneioxymethampetamine (MDMA, Ecstacy

Unknown

DSM/ICD codes

Substance Use

Not Collected

Substance Use

Not Collected

Substance Use

DSM-III-R Diagnosis

DSM Codes

25

-

25

-

25

15

30

K = Key Field



1609

1103

999.97

XXX.XX





04-30-2006

04-30-2006

04-30-2006

09-01-1998

CWMS_PROXY

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of 71

ArizonaSupplemental

5

5

6

6

Psychiatric Problem in Addition to Alcohol or Drug Problem

Psychiatric Problem in Addition to Alcohol or Drug Problem

Pregnant at Admission

Pregnant at Admission

8

G

M

S

7

N

X

Y

7

N

Y

Not collected

Substance Abuse

General Mental Health

Serious Mental Illness

Blank

no

Males

yes

Blank

no

yes

No

No

Yes

Yes

Unknown

No - female client was not pregnant at admission

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

Yes - female client was pregnant at admission

Unknown

No - female client was not pregnant at admission

Yes - female client was pregnant at admission

Not Collected

Behavioral Health Category

Pregnancy

Pregnancy

-

-

-

-

K = Key Field



2

2

1

1

7

2

6

1

7

2

1



03-31-2011

03-31-2011

CWMS_PROXY

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ArizonaSupplemental

7

7

Veteran Status

Veteran Status

7

N

X

Y

7

A

B

C

D

E

F

G

N

X

Y

Blank

No

N/A, due to age (0-16 only)

Yes

Blank

Active Military

Veteran

Retired Veteran

Disabled Veteran

Military Family Member

No Active or Veteran Military Status

Unknown

No

N/A, due to age (0-16 only)

Yes

Unknown

No

No

Yes

Unknown

Yes

Yes

Yes

Yes

No

No

Unknown

No

No

Yes

Veteran Status

Military Status

-

-

K = Key Field



7

2

2

1

7

1

1

1

1

2

2

7

2

2

1


CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

8 Living Arrangements

01

02

03

04

05

06

07

08

09

12

16

19

22

23

97

Independent

Hotel

Boarding House

Supervised/Assisted

ASH

Jail/Prison/Detention

Homeless

Other

Foster Home

Nursing Home

Home with Family

Crisis Center

OBHL level 1, 2, or 3

Transitional Housing

Blank

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


Dependent Living - clients living in a supervised setting




Homeless - clients with no fixed address; includes homeless shelter

Unknown







Unknown

Primary Residence.-

K = Key Field



03

03

02

02

02

02

01

97

02

02

03

02

02

02

97

CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

8 Living Arrangements

01

02

03

04

05

06

07

08

09

12

16

19

22

23

97

Independent

Hotel

Boarding House

Supervised/Assisted

ASH


Homeless/Homeless Shelter

Other

Foster Home

Nursing Home

Home with Family

Crisis Center

OBHL lever 1,2, or 3

Traditional Housing

Blank








Unknown







Unknown

Primary Residence12

K = Key Field



03

03

03

02

02

02

01

97

02

02

03

02

02

02

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

9

9

Source of Income/Support

Source of Income/Support

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

98

Employment

Unemployment

SSDI

SSI

AFDC/TANF

Food Stamps

No Income

Social Security

Retirement

Other

Veteran Comp

Family

Gen. Assit

98

Wages/Salary

Public Assistance

Public Assistance

Public Assistance

Public Assistance

Public Assistance

None

Retirement/Pension

Retirement/Pension

Other

Other

Other

Public Assistance

Not Collected

Incomes Sources

Not Collected

18

-

K = Key Field



01

02

02

02

02

02

21

03

03

20

20

20

02

98


CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

10

10

11

Health Insurance

Health Insurance

Expected/Actual Primary Source of Payment

1

2

3

4

5

6

7

9

97

97

98

Medicare

AHCCCS

Private

Champus/VA

Other

Blue Cross

HOM

None

Blank

All records

98

Medicare

Medicaid

Private Insurance (other than BCBS or HMO)

Other (e.g. TriCare)

Other (e.g. TriCare)

Blue Cross/Blue Shield

Health Maintenance Organization (HMO)

None

Unknown

Not Collected

Not Collected

Medical Insurance,

Not Collected

Not Collected

19

-

-

K = Key Field



03

04

01

20

20

02

06

21

97

98

98


CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

11

12

Expected/Actual Primary Source of Payment

Detailed Not in Labor Force

01

02

03

04

09

14

17

18

19

20

21

22

23

97

99

Self-Pay

Medicare

Other Government

Other Insurance

Other

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution

blank

unknown

Self-Pay

Medicare

Other Government Payments

Other Health Insurance Companies

Other

Other

Other

Other

Homemaker

Student

Retired

Disabled

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

Unknown

Unknown

Third Party Liability

Employment status

20

-

K = Key Field



01

03

05

07

09

06

06

06

01

02

03

04

05

97

97



04-30-2006

12-31-2008

CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplementalK = Key Field



CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

12 Detailed Not in Labor Force

01

02

03

04

08

14

17

18

19

20

21

22

23

24

25

26

27

97





Unemployed

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution





blank

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Other

Other

Other

Homemaker

Student

Retired

Disabled


Not Applicable

Not Applicable

Not Applicable

Not Applicable

Unknown

Employment status-

K = Key Field



96

96

96

96

96

06

06

06

01

02

03

04

05

96

96

96

96

97

CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

12

13

13

Detailed Not in Labor Force

Detailed Criminal Justice Referral Categories

Detailed Criminal Justice Referral Categories

99

98

18

20

26

34

All Others

unknown

98

AOC/JPO

ADC

Adult/Probation/Court

ADJC

All Others

Unknown

Not Collected

Probation/Parole

Prison

Probation/Parole

Prison

Not Applicable

Employment status

Not Collected

Referral Source

-

-

17

K = Key Field



97

98

03

06

03

06

96


CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

14

14

Marital Status

Marital Status

97

B

D

I

M

R

S

U

W

X

1

2

3

4

5

Blank

Registered Domestic Partner

Divorced

Single

Married

Unreported

Seperated

Unmarried

Widowed

Legally Seperated

Never married

Married

Divorced

Widowed

Seperated

Unknown

Unknown

Divorced

Never Married - includes clients who are single or whose

Now Married ( includes those living together as married)

Unknown

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


Widowed



Now Married ( includes those living together as married)

Divorced

Widowed


Marital Status,

Marital Status,

15

15

K = Key Field



97

97

04

01

02

97

03

01

05

03

01

02

04

05

03


CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

15

16

16

17

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

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

000-996

997

997-999

00

01-31

97

00

01-96

97

000-996 Days

Blank

Days, use TEDS "996"

Number arrests within last 31 days


Blank

-

01-96 Number arrests

Blank

Number of Days waiting

Unknown

Number of Days waiting

Number of Arrests

Number of Arrests

Unknown

Number of Arrests

Number of Arrests

Unknown

Days Waiting Treatment

Arrests in 30 Days prior to admission


Not Collected

23

-

-

-

K = Key Field



000-996

997

000-996

00-96

00-96

97

00-96

00-96

97



09-30-2010

01-31-2010

CWMS_PROXY

Crosswalk Report

of 71

ArizonaSupplemental

17

18

19

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

Diagnostic Code Set

Diagnostic Code (ICD-10 Form)

1

2

3

4

5

97

X

8

8

No Attendance in past month




21 or more times in past month

Blank

Unknown

Not collected

Not collected


less than once a week -1 to 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

4 or more times a week - 16 to 30 times in past 30 days

Unknown

Unknown

Not Collected

Not Collected

Social Support and Recovery

Not Collected

Not Collected

-

-

-

K = Key Field



01

02

03

04

05

97

97

8

999.9998

CWMS_PROXY

Crosswalk Report

of 71

ArizonaDischarge/NOMS

1

2

3

4

4

5

6

System Transaction at Discharge

State Code at Discharge

Reporting Date at Discharge

State Provider Identifer at Discharge

State Provider Identifer at Discharge

Client Identifier at Discharge

Co-Dependent/Collateral at Discharge

1

2

Add

No

Add

No


FIPS Code Added to Each Record

Month and Year of Submission Added to Each Record

ProviderID/Site Id

Contractor/Subcontractor/Facility

Client Identifier

Not Collected

-

AZ

-

-

2

3

-

K = Key Field



A

2


MMYYYY

1-15 characters - Provider_ID + 2 digit (01-99)

10 Characters and Unique

CWMS_PROXY

Crosswalk Report

of 71


7 Type of Treatment Service/Treatment Setting at Discharge

A01

A02

A03

A04

A05

C11

C12

C13

D14

D15

D16

D17

D19

D21

F26

F27

F28









Case Management

Personal assistance

Family Support

Peer support

Respite Care



Hospital Detox


Ambulatory -Non Intensive -Outpatient














Rehabilation/Residential - Hospital (other than detoxification)

Detoxification, 24-Hour Service, Hospital Inpatient



K = Key Field



07

07

07

07

07

07

07

07

07

07

07

07

07

07

03

01

03

CWMS_PROXY

Crosswalk Report

of 71



F29

F30

F31

H0018

H0019

H0043

H36

H37

H38



Inpatient RTC detox



Supported Housing




Detoxification, 24-Hour Service, Free Standing Residential



Rehabilation/Residential - Short Term (30 Daysor Fewer)

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


Ambulatory - Intensive -Outpatient




K = Key Field



02

03

02

04

05

05

06

06

06


CWMS_PROXY

Crosswalk Report

of 71



83840

A01

A02

A03

A04

A05

C10

C11

C12

C13

D14

D15

D16

D17

D19

D21

F26











Case Management

Personal assistance

Family Support

Peer support

Respite Care





















K = Key Field



07

07

07

07

07

07

07

07

07

07

07

07

07

07

07

07

03

CWMS_PROXY

Crosswalk Report

of 71


7

8

8

Type of Treatment Service/Treatment Setting at Discharge

Date of Last Contact or Data Update

Date of Last Contact or Data Update

F27

F28

F29

F30

F31

H0018

H0019

H0020

H0043

H36

H37

H38

1010008

Hospital Detox




Inpatient RTC detox




Supported Housing




All records

Detoxification, 24-Hour Service, Hospital Inpatient





Rehabilation/Residential - Short Term (30 Daysor Fewer)







Not Collected


Not Collected

Not Collected

-

-

-

K = Key Field



01

03

02

03

02

04

05

07

05

06

06

06

01010008


CWMS_PROXY

Crosswalk Report

of 71


9

9

10

Date of Discharge

Date of Discharge

Reason for Discharge, Transfer, or Discontinuance of Treatment

01

02

03

04

06

07

08

09

88

99

Treatment completed

Needs additional service

Closure against staff advice

Lack of contact

Incarceration

Death

Move out of area

Inter RBHA transfer

BHS Administrative action


Treatment Completed

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

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


Incarerated or released by or to courts

Death


Transferred to Another Treatment Program or Facility



Date of Movement

Date of Disenrollment

Event reason - dis-enroll reason

9

19

~

K = Key Field



01

07

02

02

05

06

07

04

07

07


MMDDYYYY

CWMS_PROXY

Crosswalk Report

of 71


10 Reason for Discharge, Transfer, or Discontinuance of Treatment

-

0

1

2

3

4

6

7

8

88

9

99

R-01

R-02

R-03

R-04

R-06

R-07

Event reason blank

One time consultation

Treatment complete

Needs additional services

Closure against staff advive

Lack of contact

Incarceration

Death

Moved out of area


Inter RBHA transfer


Treatment complete

Change in eligibility

Client declined further service

Lack of contact

Incarceration

Death

Unknown - This code will still be accepted by states shouls use 97 Unknown

Unknown - This code will still be accepted by states shouls use 97 Unknown

Treatment Completed





Death





Treatment Completed





Death

Event reason - dis-enroll reason~

K = Key Field



08

08

01

07

02

02

05

06

07

07

04

07

01

07

02

02

05

06

CWMS_PROXY

Crosswalk Report

of 71


10

11

12

13

14

Reason for Discharge, Transfer, or Discontinuance of Treatment

Provider Identifier at Admission

Client Identifier at Admission

Co-Depentent/Collateral at Admission

Client Transaction Type (pulled from admission dataset)

R-08

R-09

R-10-01

R-10-03

R-10-04

2

A

Moved out of area

Inter RBHA transfer

Treatment complete

Client declined further service

Lack of contact

No

Admission



Treatment Completed



Comes from admission file


Client

Initial Admission (SA)

Event reason - dis-enroll reason

ProviderID/Site Id

Client Identifier

Co-Dependent/Collateral Data - Not Collected

Type of Intake

~

-

3

-

8

K = Key Field



07

04

01

02

02

-

-

2

A


CWMS_PROXY

Crosswalk Report

of 71


15 Date of Admission (pulled from admission dataset)

EOC Start Date-

K = Key Field



MMDDYYYY

CWMS_PROXY

Crosswalk Report

of 71


16 Type of Service at Admission (pulled from admission dataset)

A01

A02

A03

A04

A05

C11

C12

C13

D14

D15

D16

D17

D19

D21

F26

F27

F28

F29









Case Management

Personal assistance

Family Support

Peer support

Respite Care



Hospital Detox

















Rehabilitation/Residential - Hospital (other thanDetoxification)

Detoxification, 24-hour service - Hospital Inpatient


Detoxification , 24 hour service , Free-StandingResidential


K = Key Field



07

07

07

07

07

07

07

07

07

07

07

07

07

07

03

01

03

02

CWMS_PROXY

Crosswalk Report

of 71



F30

F31

H0018

H0019

H0043

H36

H37

H38


Inpatient RTC detox



Supported Housing






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

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






K = Key Field



03

02

04

05

05

06

06

06


CWMS_PROXY

Crosswalk Report

of 71



83840

A01

A02

A03

A04

A05

C10

C11

C12

C13

D14

D15

D16

D17

D19

D21

F26

F27











Case Management

Personal assistance

Family Support

Peer support

Respite Care



Hospital Detox


















Detoxification, 24-hour service - Hospital Inpatient


K = Key Field



07

07

07

07

07

07

07

07

07

07

07

07

07

07

07

07

03

01

CWMS_PROXY

Crosswalk Report

of 71


16

17

18

Type of Service at Admission (pulled from admission dataset)

Date of Birth (pulled from admission dataset)

Gender (pulled from admission dataset)

F28

F29

F30

F31

H0018

H0019

H0020

H0043

H36

H37

H38




Inpatient RTC detox




Supported Housing








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









Date Of Birth

Sex (M/F)

-

13

14

K = Key Field



03

02

03

02

04

05

07

05

06

06

06

-


MMDDYYYY

CWMS_PROXY

Crosswalk Report

of 71


18

19

19

Gender (pulled from admission dataset)

Race (pulled from admission dataset)

Race (pulled from admission dataset)

1

2

7

97

All N

Y

Y

Y

Y

Y

Y

Male

Female

Blank

Blank

All race categories checked no

Native Hawaiian

White

More than one race checked yes

Asian


Black

Male

Female

Unknown


Unknown

Unknown

Native Hawaiian or other Pacific Islander

White

Two or more races

Asian

American Indian


Sex.

Race

Race.

-

15

-

K = Key Field



1

2

7

-

97

97

23

05

21

13

02

04


CWMS_PROXY

Crosswalk Report

of 71


20

20

Ethnicity (pulled from admission dataset)

Ethnicity (pulled from admission dataset)

N

Y

Not Hispanic

Hispanic

Not of Specific Hispanic or Latino Origin

Hispanic or Latino - specific origin not specified


Ethnicity.

Ethnicity,

-

16

K = Key Field



05

06

-


CWMS_PROXY

Crosswalk Report

of 71


21

21

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

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

0001

0201

0302

0401

0501

0706

0902

1001

1201

1308

1605

1703

2002

97

none past 30 days

Alcohol

Cocaine/crack

Marijuana/Hashish

Heroin/morphine


Hallucingens


Other stimulants

Benzodiazepines


Inhalants

Other drugs

Blank

None

Alcohol

Cocaine/Crack

Marijuana/Hashish

Heroin


Hallucinogens

Methampetamine/SPeed

Other Stimulants

Benzodiazepines

Other Sedatives or Hypontics

Inhalants

Other

Unknown


Not Collected

-

-

K = Key Field



01

02

03

04

05

07

09

10

12

13

16

17

20

97


CWMS_PROXY

Crosswalk Report

of 71


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

1

2

3

4

5

6

7

8

96

97





1 or more per day





Blank

No Use in the Past Month

1-3 Times in the Past Month

1-2 Times in the Past Week


Daily




Not Applicable

Unknown

Frequency of Use-

K = Key Field



01

02

03

04

05

01

01

01

96

97

CWMS_PROXY

Crosswalk Report

of 71


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

1

2

3

4

5

97





1 or more per day

Blank


1-3 Times in the Past Month



Daily

Unknown

Frequency of Use-

K = Key Field



01

02

03

04

05

97


CWMS_PROXY

Crosswalk Report

of 71


23 Living Arrangements at Discharge

01

02

03

04

05

06

07

08

09

12

16

19

22

23

97

Independent

Hotel

Boarding House

Supervised/Assisted

ASH


Homeless

Other

Foster Home

Nursing Home

Home with Family

Crisis Center

OBHL level 1, 2, or 3

Transitional Housing

Blank








Unknown







Unknown

Primary Residence.-

K = Key Field



03

03

02

02

02

02

01

97

02

02

03

02

02

02

97

CWMS_PROXY

Crosswalk Report

of 71


23 Living Arrangements at Discharge

01

02

03

04

05

06

07

08

09

12

16

19

22

23

97

Independent

Hotel

Boarding House

Supervised/Assisted

ASH


Homeless/Homeless Shelter

Other

Foster Home

Nursing Home

Home with Family

Crisis Center

OBHL lever 1,2, or 3

Traditional Housing

Blank








Unknown







Unknown

Primary Residence12

K = Key Field



03

03

03

02

02

02

01

97

02

02

03

02

02

02

97


CWMS_PROXY

Crosswalk Report

of 71


24 Employment at Discharge

01

02

03

04

08

14

17

18

19

20

21

22

23

25

26

27

97

99





Unemployed

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution




blank

unknown

















Unknown

Unknown

Employment status-

K = Key Field



01

02

01

02

03

04

04

04

04

04

04

04

04

02

04

02

97

97


CWMS_PROXY

Crosswalk Report

of 71

ArizonaDischarge/NOMSK = Key Field



CWMS_PROXY

Crosswalk Report

of 71


24 Employment at Discharge

01

02

03

04

08

14

17

18

19

20

21

22

23

24

25

26

27

97





Unemployed

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution





blank


















Unknown

Employment status-

K = Key Field



01

02

01

02

03

04

04

04

04

04

04

04

04

01

02

04

02

97

CWMS_PROXY

Crosswalk Report

of 71


24

25

Employment at Discharge

Detailed Not In Labor Force at Discharge

99

14

17

18

19

20

21

22

23

97

99

unknown

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution

blank

unknown

Unknown

Other

Other

Other

Homemaker

Student

Retired

Disabled


Unknown

Unknown

Employment status

Employment status

-

-

K = Key Field



97

06

06

06

01

02

03

04

05

97

97


CWMS_PROXY

Crosswalk Report

of 71


25 Detailed Not In Labor Force at Discharge

01

02

03

04

08

14

17

18

19

20

21

22

23

24

25

26

27

97





Unemployed

Volunteer



Homemaker

Student

Retired

Disabled

Inmate Institution





blank

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Other

Not Applicable

Not Applicable

Homemaker

Student

Retired

Disabled


Not Applicable

Not Applicable

Not Applicable

Not Applicable

Unknown

Employment status-

K = Key Field



96

96

96

96

96

06

96

96

01

02

03

04

05

96

96

96

96

97

CWMS_PROXY

Crosswalk Report

of 71


25

26

26

Detailed Not In Labor Force at Discharge

Number of Arrests in 30 Days Priorto Discharge

Number of Arrests in 30 Days Priorto Discharge

99

00

01-31

97

unknown



Blank

Unknown

Number of Arrests

Number of Arrests

Unknown

Employment status

Not Collected


-

-

-

K = Key Field



97

00-96

00-96

97


CWMS_PROXY

Crosswalk Report

of 71


27

27

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

1

2

3

4

5

97

X





21 or more times in past month

Blank

Unknown


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 a week - 8 to 15 times in past 30 days

4 or more times a week - 16 to 30 times in past 30 days

Unknown

Unknown

Social Support and Recovery

Not Collected

-

-

K = Key Field



01

02

03

04

05

97

97


REPORT CROSSWALK TO STATE

Crosswalk Management System

End of Report

crosswalk management system - dasis home page · k = key field item notreatment episode data set...

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