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REPORT CROSSWALK TO STATE

27-DEC-16 09:12Report Date :

Run by :

Report :

CWMS_PROXY

Filename :

Crosswalk Management System

CWMS_PROXY

Crosswalk Report

of 67

Status : VA

Start Date : 01-JAN-05End Date :

Follow-up :

Media ID : NJ-SAMS

New JerseySystem

K

1

2

3

System Transaction Type

State Code

Reporting Date

A

C

D

-

Add

Change

Delete

NJ

Add

Change

Delete

State Postal Abbreviation


FIPS State Code

Month and year data file submitted

~

NJ

~

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

SAMS 2005 - New Jersey Treatment Episode Data SetVersion : 1

A

C

D

-

.

MMYYYY Format

General reporting comments: [.] denotes [TableName.FieldName(s)]


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

K

K

K

K

K

1

2

3

4

5

State Provider Identifer

Client Identifer (Admission)

Co-Dependent/Collateral

Client Transaction Type

Date of Admission

-

1

2

A

T

Unknown (None of the above)

Alcohol/Drug Abuser

Co-Dependent/Family

Admission

Transfer

No

No

Yes

Admission (SA)

Transfer/Change in Service (SA)

Provider ID

ID Combo (Client ID + Episode Code + Event Code)

Co-Dependent/collateral


Date of Admission

~~

~~

~~

~~

~~

K = Key Field



2

2

1

A

T

"NJ" + 6 characters

14 or 15 characters (depending if episode is 1 or 2 digits)

MMDDYYYY Format


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

6 Prior Treatment Episodes

-

0

1

2

3

4

>4


0

1

2

3

4

5 or more

Unknown

0 Previous Episodes

1 Previous Episodes

2 Previous Episodes

3 Previous Episodes

4 Previous Episodes

5 Or More Previous Episodes

No. of Prior treatment episodes~~

K = Key Field



7

0

1

2

3

4

5


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

7 Principal Source of Referral

-

-

1

10

11

2

31

32

33

34

41

42

43

44

45

46

47

48


n/a

Self

Hot Line

Other Referral Source

Family/Friend

AddictionTreatment Program

County Drug and Alcohol Coordinator

South New Jersey Initiative

Other Addictions Services

Municipality - Municipal Court

County - Family Court

County - Drug Court

County - Probation

County - Detention Center

County - Other (Pre-Trial Intervention,Judge,....)

STATE - NJ Department of Corrections

STATE - NJ State Parole Board/DistrictOffice

Unknown

Other Health Care Provider

Individual (includes self-referral))

Other Community Referral

Unknown


Alcohol/Drug Abuse Provider




Court/Criminal Justice/DUI/DWI








Principal source of referral~~

K = Key Field



97

03

01

06

97

01

02

02

02

03

07

07

07

07

07

07

07

07


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


49

5

50

51

52

61

62

63

64

65

71

72

73

74

75

81

82

83

84

FEDERAL - US Federal Prison

IDRC

FEDERAL - US Federal Court

Juvenile Justice Commission (JJC)

Other Corrections Program

Mental Health Screening Center

Mental Health Provider/Clinic

Hospital

Other Mental Health

MICA Program

County or Municipal Health Department

Hospital, Crisis Emergency Room

Other Hospital

Health Care Agency/Private Physician

Other Medical/Health

NJ Dept. Human Services - DYFS

WFNJ - Substance Abuse Initiative (SAI)

Substance Abuse Research Demonstration

Other Welfare/Social Service





















K = Key Field



07

07

07

07

07

03

03

03

03

03

03

03

03

03

03

06

06

06

06


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


9 Employee Assistance ProgramEmployer/Employer Assistance ProgramEAP


K = Key Field



05

No longer effective as of: 11-05-2014


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


-

-

1

10

11

2

31

32

33

34

41

42

43

44

45

46

47

48


n/a

Self

Hot Line

Other Referral Source

Family/Friend

AddictionTreatment Program

County Drug and Alcohol Coordinator

South New Jersey Initiative

Other Addictions Services

Municipality - Municipal Court

County - Family Court

County - Drug Court

County - Probation

County - Detention Center

County - Other (Pre-Trial Intervention,Judge,....)

STATE - NJ Department of Corrections

STATE - NJ State Parole Board/DistrictOffice

Unknown

School (Educational)


















K = Key Field



97

04

01

06

06

01

02

02

02

02

07

07

07

07

07

07

07

07


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


49

5

50

51

52

61

62

63

64

65

71

72

73

74

75

81

82

83

84

FEDERAL - US Federal Prison

IDRC

FEDERAL - US Federal Court


Other Corrections Program

Mental Health Screening Center

Mental Health Provider/Clinic

Hospital

Other Mental Health

MICA Program

County or Municipal Health Department

Hospital, Crisis Emergency Room

Other Hospital

Health Care Agency/Private Physician

Other Medical/Health

NJ Dept. Human Services - DYFS

WFNJ - Substance Abuse Initiative (SAI)

Substance Abuse Research Demonstration

Other Welfare/Social Service





















K = Key Field



07

07

07

07

07

03

03

03

03

03

03

03

03

03

03

06

06

06

06


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

7

8

9

Principal Source of Referral

Date of Birth

Gender

9

-

1

2

3

4

Employee Assistance Program


Male

Female

Transgender

Other

Employer/Employer Assistance ProgramEAP

Unknown

Male

Female

Unknown

Unknown

Principal source of referral

DOB

Gender

~~

~~

~~

K = Key Field



05

7

1

2

7

7

mmddyyyy


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

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

-

-

-

1

2

3

4

5

6

n/a


if Race2 has value between and 6 inclusive and equal to Race1

White

Black

Asian

Alaskan Native

American Indian

Native Hawaiian or other Pacific Islander

Other Single Race

Unknown

Two or More Races

White

Black or African American

Asian

Alaska Native (Aleut, Eskimo, Indian)

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

Native Hawaiians or Other Pacific Islanders

Race~~

K = Key Field



20

97

21

05

04

13

01

02

23


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

10

11

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

Hispanic or Latino Origin ( Ethnicity)

-

1

2

3

4

5

6

-

1

2

3

4

5

6


White

Black

Asian

Alaskan Native

American Indian



Not of Hispanic Orgin

Puerto Rican

Mexican

Cuban

Dominican

Other Hispanic

Unknown

White


Asian

Alaska Native (Aleut, Eskimo, Indian)

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

Native Hawaiians or Other Pacific Islanders

Unknown

Not of Hispanic or Latino Origin

Puerto Rican

Mexican

Cuban

Other Specific Hispanic

Hispanic or Latino - Specific Origin not Specified

Race

Ethnicity

~~

~~

K = Key Field



97

05

04

13

01

02

23

97

05

01

02

03

04

06



CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

12 Education

-

0

1

10

11

12

13

14

15

16

17

18

19-20

2

3

4

5

6


Less Than One Grade Completed

Grade 1

Grade 10

Grade 11

12th Grade or GED

1st Year of College/University (Freshman)

2nd Year of College University (Sophomore) or Associate Degree

3rd Year of College/University (Junior)

4th Year of College (Senior) or Bachelor's Degree

Some Post-Graduate Study - Degree not completed

Master's Degree completed

Post graduate study

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Unknown


Grade 1

Grade 10

Grade 11

12th Grade or GED

1st year of College/Iniversity (Freshman)

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

Grade 3

Grade 4

Grade 5

Grade 6

Education~~

K = Key Field



97

00

01

10

11

12

13

14

15

16

17

18

19-25

02

03

04

05

06


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

12

12

Education

Education

7

8

9

-

0

1-20

Grade 7

Grade 8

Grade 9



Years of School (Highest Grade) Completed

Grade 7

Grade 8

Grade 9

Unknown


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

Education

Education

~~

~~

K = Key Field



07

08

09

97

00

01-25



CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

13 Employment Status

-

1

10

2

3

4

5

6

7

8

9

Unknwn (None of the above)

Full-Time Work or Military

Disabled

Part-Time (Regular Hours)

Student

Homemaker

Retired

Unemployed: Actively looking for work

Unemployed: Not looking for work

Unemployed: Volunteer Work

Unemployed: Living in an institution

Unknown

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

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

Part Time - works less tahn 35 hours per week




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




Employment Status (Admission and Discharge)~~

K = Key Field



97

01

04

02

04

04

04

03

04

04

04


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

13 Employment Status

-

1

10

11

2

3

4

5

6

7

8

9




Disabled


Part-Time (Not Regular Hours)

Student

Homemaker

Retired




Unknown













K = Key Field



97

01

04

04

02

02

04

04

04

03

04

03



CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

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

-

-

-

-

1

10

11

12

13

14

15

16

17

18

19

2

20

n/a

n/a

n/a


Alcohol

GHB

Hallucingens - LSD

Hallucingens - PCP

Hallucingens - Other

Inhalants

Ketamine

Methadone (non prescription)

Opiate - Other

Oxycontin

Rohypnol

Heroin

Other (Phenytoin, etc)

Over-the-Counter

Other Non-Benzodiazapine Tranquilizers

Other Non-Barbituate Sedatives or Hypnotics

Unknown

Alcohol

Other

Hallucinogens

PCP

Hallucinogens

Inhalants

Other

Non-Prescription Methadone

Other Opiates and Synthetics


Benzodiazepines

Heroin

Other

Primary Drug (Admission and Discharge)~~

K = Key Field



18

14

16

97

02

20

09

08

09

17

20

06

07

07

13

05

20


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


21

22

23

24

25

26

27

28

29

3

30

31

32

33

34

35

36

37

None

Other Amphetamines

Buprenorphine (non-prescription)

Codeine

Propoxyphene (Darvon)

Meperidine (Demerol)

Hydromorphone (Dilaudid)

Pentazocine

Hydrocodone (Vicodin)

Marijuana/Hashish

Tramadol (Ultram)

Methylphenidate (Ritalin)

Alprazolam (Xanax)

Chlordiazepoxide (Librium)

Clorazepate (Tranzene)

Diazepam (Valium)

Flurazepam (Dalmane)

Lorazepam (Ativan)

None

Other Amphetamines








Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)


Other Stimulants

Benzodiazepines

Benzodiazepines

Benzodiazepines

Benzodiazepines

Benzodiazepines

Benzodiazepines


K = Key Field



01

11

07

07

07

07

07

07

07

04

07

12

13

13

13

13

13

13


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


38

39

4

5

6

7

8

9

Synthetic Cannabinoids (Synthetic Marijuana, K2, Spice)

Bath Salts

Cocaine - Powder

Crack

Amphetamines/Methamphetamines

Barbiturates

Benzodiazepines

MDMA (MOLLY), Ecstasy

Other

Other Amphetamines

Cocaine, Crack

Cocaine, Crack

Methamphetamine

Barbiturates

Benzodiazepines

Other Amphetamines


K = Key Field



20

11

03

03

10

15

13

11


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum


-

1

10

11

12

13

14

15

16

17

18

19

2

20

21

22

3


Alcohol

GHB

Hallucingens - LSD

Hallucingens - PCP


Inhalants

Ketamine


Opiate - Other

Oxycontin

Rohypnol

Heroin


None

Other Amphetamines

Marijuana/Hashish

Unknown

Alcohol

Other

Hallucinogens

PCP

Hallucinogens

Inhalants

Other




Benzodiazepines

Heroin

Other

None

Other Amphetamines

Marijuana, Hashish ( includesTHC and other Cannabis Sativa preperations)


K = Key Field



97

02

20

09

08

09

17

20

06

07

07

13

05

20

01

11

04


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

14

15

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

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

4

5

6

7

8

9

-

-

-

1

2

3

4

5

Cocaine - Powder

Crack


Barbiturates

Benzodiazepines


n/a

n/a


Oral

Inhalantion/Sniffing

Smoking

Intramuscular/Sub-Cutaneous

Intravenous

Cocaine, Crack

Cocaine, Crack

Methamphetamine

Barbiturates

Benzodiazepines

Other Amphetamines

Not Applicable

Other

Unknown

Oral

Inhalation

Smoking

Injection (IV or intramuscular, intradermal or subcutaneous)


Primary Drug (Admission and Discharge)

Primary Route

~~

~~

K = Key Field



03

03

10

15

13

11

96

20

97

01

03

02

04

04



CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

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

-

1

2

3

4

5


Oral

Inhalantion/Sniffing

Smoking

Intramuscular/Sub-Cutaneous

Intravenous


No use past month

Less than weekly

1 to 2 times per week


Daily

Unknown

Oral

Inhalation

Smoking



Unknown

No use in the past month

1-3 times in past month

1-2 times per week

3-6 times per week

Daily

Primary Route

Primary Frequency (Admission and Discharge)

~~

~~

K = Key Field



97

01

03

02

04

04

97

01

02

03

04

05

No longer effective as of:


11-05-2014

11-05-2014


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

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

-

-

-

01-95

n/a


No use past month

Less than weekly



Daily

n/a

n/a


Age

Not Applicable

Unknown

No use in the past month


1-2 times per week

3-6 times per week

Daily

Newborn with a substance dependecy problem

Not Applicable

Unknown

Age at First Use, in years


Primary Age

~~

~~

K = Key Field



96

97

01

02

03

04

05

00

96

97

01-95


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

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

-

-

07-96


Unknown - ages 00-06 not collected

Age

Unknown

Unknown

Age at First Use, in years

Primary Age~~

K = Key Field



97

97

01-95



CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

K 18 Type of Services

1

10

11

12

13

14

15

2

3

4

5

6

7

8

9

Standard/Traditional Outpatient

Detox-Hospital Inpatient

Detox-Outpatient (Non-Methadone)

OPIOID - Methadone Outpatient

Detox-Methadone Outpatient

Non-traditional Outpatient

Intensive Outpatient -OPIOID- Maintenance

Intensive Outpatient

Partial-Hospitalization

Transitional Care/Extended Care

Halfway House

Long-Term Residential

Short-Term Residential (Medically Monitored)

Hospital-Based (acute) Residential

Detox-free Standing Residential (Sub-Acute)

Ambulatory - Non-Intensive Outpatient

Detoxification - Hospital Inpatient ( Detox, 24 hour Service)

Ambulatory Detoxification




Ambulatory - Intensive Outpatient



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



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

Rehabilitation/Residential - Hospital (other thandetox)

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

Level of Care ( Admission and Discharge)~~

K = Key Field



07

01

08

07

08

07

06

06

06

05

05

05

04

03

02


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

19 Medication-Assisted Opioid Therapy

-

-

-

-

-

-

-

-

-

-

Yes - Vivitrol and primary drug IS an Opioid

Yes - Buprenorphene/Suboxone TX

Yes - Methadone TX

No - Psychotropic drug

n/a

No - Naltrexone

No - Acamprosate

No


No - Vivitrol and primary drug IS Alcohol

Yes

Yes

Yes

No

Not Applicable

No

No

No

Unknown

No

Methadone Maintenance~~

K = Key Field



1

1

1

2

6

2

2

2

7

2


CWMS_PROXY

Crosswalk Report

of 67

New JerseyMinimum

19 Medication-Assisted Opioid Therapy

0

1

2

3

4

5

5

6

7

8

9

No

Yes - Methadone TX

Yes - Buprenophene/Suboxone TX

No- Acamprosate

No - Naltrexone

Yes - Vivitrol, if primary drug IS an Opiod

No - Vivitrol, if primary drug IS NOT an Opiod

No - Psychotropic drug

None (no record)

Other

Don't Know

No

Yes

Yes

No

No

Yes

No

No

Unknown

Unknown

Unknown

Methadone Maintenance~~

K = Key Field



2

1

1

2

2

1

2

2

7

7

7



CWMS_PROXY

Crosswalk Report

of 67

New JerseySupplementalK = Key Field




CWMS_PROXY

Crosswalk Report

of 67

New JerseySupplemental

1 Detail Drug Code, Primary

-

-

1

10

11

12

13

14

15

16

17

18

19

2

20

22

23

24


***MDS 14 is 01 (none)

Alcohol

GHB

Hallucingens - LSD

Hallucingens - PCP


Inhalants

Ketamine


Opiate - Other

Oxycontin

Rohypnol

Heroin


Other Amphetamines


Codeine

Unknown

Not Applicable

Alcohol

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

LSD

PCP or PCP Combinations

DMT, mescaline, peyote,STD and Other Hallucinogens

Aerosols

Ketamine - ( Special K)

Non - Prescription Methadone

Other Opiates or Synthetics

Oxycodone (Oxycotin)

Flutirazepram (Rohypnol)

Heroine

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

Other Amphetamines

Buprenorphine (Subutex,Suboxone)

Codeine


K = Key Field



9997

9996

0201

2003

0901

0801

0902

1701

2004

0601

0706

0703

1309

0501

2002

1109

0710

0701


CWMS_PROXY

Crosswalk Report

of 67



25

26

27

28

29

3

30

31

32

33

34

35

36

37

38

39

4

5

6




Pentazocine


Marijuana/Hashish

Tramadol (Ultram)


Alprazolam (Xanax)



Diazepam (Valium)


Lorazepam (Ativan)


Bath Salts

Cocaine - Powder

Crack





Pentazocine (Talwin)


Marijuana/Hashish,THC and any other cannabis sativa preparation

Tramadol (Ultram)

Methylphenidate - (Ritalin)

Alprazolam (Xanax)



Diazepam (Valium)


Lorazepam (Ativan)


Other Amphetamines

Other Cocaine

Crack

Methamphetamine/Speed


K = Key Field



0702

0704

0705

0707

0708

0401

0709

1202

1301

1302

1303

1304

1305

1306

2002

1109

0302

0301

1001


CWMS_PROXY

Crosswalk Report

of 67



7

8

9

Barbiturates

Benzodiazepines


Phenobarbital

Diazepam (Valium)

Methyleneioxymethampetamine (MDMA, Ecstacy


K = Key Field



1501

1304

1103


CWMS_PROXY

Crosswalk Report

of 67



-

-

1

10

11

12

13

14

15

16

17

18

19

2

20

22

3

4

***MDS 14 is 01 (none)


Alcohol

GHB

Hallucingens - LSD

Hallucingens - PCP


Inhalants

Ketamine


Opiate - Other

Oxycontin

Rohypnol

Heroin


Other Amphetamines

Marijuana/Hashish

Cocaine - Powder

Not Applicable

Unknown

Alcohol

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

LSD

PCP or PCP Combinations

DMT, mescaline, peyote,STD and Other Hallucinogens

Aerosols

Ketamine - ( Special K)

Non - Prescription Methadone

Other Opiates or Synthetics

Oxycodone (Oxycotin)

Flutirazepram (Rohypnol)

Heroine


Other Amphetamines

Marijuana/Hashish,THC and any other cannabis sativa preparation

Other Cocaine


K = Key Field



9996

9997

0201

2003

0901

0801

0902

1701

2004

0601

0706

0703

1309

0501

2002

1109

0401

0302


CWMS_PROXY

Crosswalk Report

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1

2

2

3

3

Detail Drug Code, Primary

Detail Drug Code, Secondary

Detail Drug Code, Secondary

Detail Drug Code, Tertiary

Detail Drug Code, Tertiary

5

6

7

8

9

Crack


Barbiturates

Benzodiazepines


Crack

Methamphetamine/Speed

Phenobarbital

Diazepam (Valium)

Methyleneioxymethampetamine (MDMA, Ecstacy

Same as Detail Drug Code, Primary









~~

~~

~~

~~

~~

K = Key Field



0301

1001

1501

1304

1103

_

_

_

_




11-05-2014

11-05-2014

11-05-2014


CWMS_PROXY

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4

5

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

Psychiatric Problem in Addition to Alcohol or Drug Problem

999.98

-

0

1-30

9

-

0

1

9

Not Collected


No

Yes

Don't Know


No

Yes

Don't Know

Not Collected

Unknown

No

Yes

Unknown

Unknown

No

Yes

Unknown

Not Collected

Psych Problem In Addition to Alcohol or Drug

Psych Problem In Addition to Alcohol or Drug

~~~

~~~

~~~

K = Key Field



999.98

7

2

1

7

7

2

1

7



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6

6

7

Pregnant at Admission


Veteran Status

-

0

1

9

-

-

0

1

2

9

-

0

1


No

Yes

Don't know


Male client

No

Yes

No

Don't know


No

Yes

Unknown

No - female client was not pregnant at admission

Yes - female client was pregnant at admission

Unknown

Unknown

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


Yes - female client was pregnant at admission


Unknown

Unknown

No

Yes



Veteran Status

~~~

~~~

~~~

K = Key Field



7

2

1

7

7

6

2

1

2

7

7

2

1



CWMS_PROXY

Crosswalk Report

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8

8

9

Living Arrangements

Living Arrangements

Source of Income/Support

-

1

2

3

4

-

1

2

3

4

98


Dependent Living/Institution

Homeless - Shelter

Homeless - Streets

Independent Living


Homeless - Shelter

Homeless - Streets


Independent Living

Not Collected

Unknown

Dependent Living - clients living in a supervised setting

Homeless - clients with no fixed address; includes homeless shelter


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

Unknown





Not Collected

Living Arrangement (Admission and Discharge)


Not Collected

~~~

~~~

~~~

K = Key Field



97

02

01

01

03

97

01

01

02

03

98



11-05-2014

11-05-2014


CWMS_PROXY

Crosswalk Report

of 67


9

10

Source of Income/Support

Health Insurance

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Wages/salary

Public assistance

Retirement/pension

Unknown (All variables not equal to 1)

Other

None

Disability

NJ Family Care

BCBS, Aetha....

Medicare

Medicaid


Other

VA/Champus

Uninsured

HMO, Provider Network, PPO...

Wages/Salary

Public Assistance

Retirement/Pension

Unknown

Other

None

Disability

Private Insurance (other than BCBS or HMO)

Blue Cross/Blue Shield

Medicare

Medicaid

Unknown

Other (e.g. TriCare)

Other (e.g. TriCare)

None

Health Maintenance Organization (HMO)

Source of Income

Health Insurance

~~~

~~~

K = Key Field



01

02

03

97

20

21

04

01

02

03

04

97

20

20

21

06

This is a T/F set up - check box for that that converts to our code


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11 Expected/Actual Primary Source of Payment

-

-

-

1

10

11

12

13

14

15

17

18

19

2

20

21

22

23

Unknown (None of the other options)

n/a

n/a

Child Welfare Reform Progerm (CWRP)

Driving Under Influence Initiative (DUII)

South Jersey Initiative (SJI)

Not assigned for any payer


Woman's Set Aside

HIV Set Aside

Parole (DOC - CSAT)

Parole Day Reporting/Aftercare

SAMHSA - HIV

Work First NJ Substance Abuse Initiative (WFNJ-SAI)

Other Mental Health Services

Ryan White

No Reimbrusemant Source/No Fee

Patient Incentive Program

Unknown

Blue Cross/Blue Shield

Worker's Compensation

Other Government Payments



Other










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


Expected Source of Payment~~~

K = Key Field



97

02

06

05

05

05

09

05

05

05

05

05

05

05

05

05

08

05



CWMS_PROXY

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24

25

3

30

31

32

33

4

5

51

52

53

54

55

6

7

8

9

Other

SAMHSA - General

Slot - DAS Non-Initiative

Family Pay

Private Insurance

Medicaid

Medicare

Drug Court - Slotted

Drug Court - Fee for Services (DC-FFS)

Chapter 51

Enhancement

Direct County Funding

Youth Services Commission

Other County Funding

Department of Corrections (DOC)

Medically Assisted Treatment Initiative (MATI) FFS

MATI Mobile Medication Unit (MMU)

State Parole Board (SPB)

Other



Self-Pay

Other Health Insurance Companies

Medicaid

Medicare













K = Key Field



09

05

05

01

07

04

03

05

05

05

05

05

05

05

05

05

05

05


CWMS_PROXY

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-

1

10

11

13

14

15

16

17

18

19

2

20

21

22

25

3

30

Unknown (None of the other options)

Child Welfare Reform Progerm (CWRP)

Driving Under Influence Initiative (DUII)

South Jersey Initiative (SJI)


Woman's Set Aside

HIV Set Aside

Other

Parole (DOC - CSAT)

Parole Day Reporting/Aftercare

SAMHSA - HIV

Work First NJ Substance Abuse Initiative (WFNJ-SAI)

Other Mental Health Services

Ryan White

No Reimbrusemant Source/No Fee

SAMHSA - General

Slot - DAS Non-Initiative

Family Pay

Unknown







Other







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



Self-Pay


K = Key Field



97

05

05

05

05

05

05

09

05

05

05

05

05

05

08

05

05

01



CWMS_PROXY

Crosswalk Report

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31

32

33

4

5

51

52

53

54

55

6

7

8

9

Private Insurance

Medicaid

Medicare

Drug Court - Slotted

Drug Court - Fee for Services (DC-FFS)

Chapter 51

Enhancement

Direct County Funding

Youth Services Commission

Other County Funding

Department of Corrections (DOC)

Medically Assisted Treatment Initiative (MATI) FFS

MATI Mobile Medication Unit (MMU)

State Parole Board (SPB)

Other Health Insurance Companies

Medicaid

Medicare













K = Key Field



07

04

03

05

05

05

05

05

05

05

05

05

05

05



CWMS_PROXY

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12

12

Detailed Not in Labor Force

Detailed Not in Labor Force

-

10

3

4

5

7

9

-

10

11

4

5

6

8


Disabled

Student

Homemaker

Retired





Disabled

Student

Homemaker

Retired


Unknown

Disabled

Student

Homemaker

Retired

Other

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

Unknown


Disabled

Student

Homemaker

Retired

Other

Employment Status (Admission and Discharge)


~~

~~

K = Key Field



97

04

02

01

03

06

05

97

05

04

02

01

03

06



CWMS_PROXY

Crosswalk Report

of 67


13 Detailed Criminal Justice Referral Categories

-

-

-

-

-

-

-

-

-

Case Pending

Probation Case

DYFS or Family Court

Drug Court

No Legal Problem

DWI License Suspension

Other

Unknown (None of the Above)

Jail/Prison Inmate

State/Federal Court

Probation/Parole

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

Diversionary Program (E.G. TASC)

Not Applicable

DUI/DWI

Other

Unknown

Prison

Detailed Criminal Justice Referral~~~

K = Key Field



01

03

04

05

96

07

08

97

06




CWMS_PROXY

Crosswalk Report

of 67


13

14

Detailed Criminal Justice Referral Categories

Marital Status

-

-

-

-

-

-

-

-

-

-

1

2

3

4

5

Case Pending

Probation/Parole

DYFS or Family Court

Drug Court

No Legal Problem

DWI License Suspension

Other

Unknown (None of the Above)

Jail/Prison Inmate


Never Married

Married

Widowed

Separated

Divorced

State/Federal Court

Probation/Parole

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

Diversionary Program (E.G. TASC)

Not Applicable

DUI/DWI

Other

Unknown

Prison

Unknown

Never Married - includes clients who are single or whose

Now Married ( includes those living together as married)

Widowed

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

Divorced

Detailed Criminal Justice Referral

Marital Status

~~~

~~~

K = Key Field



01

03

04

05

96

07

08

97

06

97

01

02

05

03

04




CWMS_PROXY

Crosswalk Report

of 67


14

15

15

16

Marital Status

Days Waiting to Enter Treatment


Number of Arrests in the 30 Days Prior to Admission

-

1

2

3

4

5

6

998

-

0-996

-

0-96


Single

Married

Separated

Divorced

Widowed

Civil Union

Not Collected

Unknown (Not between 0 and 96 inclusive)

Day(s)


Arrest(s)

Unknown

Never Married - includes clients who are single or whose


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

Divorced

Widowed


Not Collected

Unknown

Number of Days waiting

Unknown

Number of Arrests

Marital Status

Not Collected


Number of Arrests in 30 Days Prior to Admission

~~~

~~~

~~~

~~~

K = Key Field



97

01

02

03

04

05

02

998

997

000-996

97

00-96



CWMS_PROXY

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16

17

Number of Arrests in the 30 Days Prior to Admission

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

-

1

2

3

4

5

6

98

Unknown (None of the other codes)

No attendance in past month





Some attendance in past month, but frequence unknown

n/a

Unknown

No Attendance in past month

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

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

Not Collected

Not Collected

Frequency of attendance at self-help programs in past 30 days prior to admission

~~~

~~~

K = Key Field



97

01

02

03

04

05

06

98



12-30-2005

11-05-2014


CWMS_PROXY

Crosswalk Report

of 67


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

-

1

2

3

4

5

6


No attendance in past month





Some attendance in past month, but frequence unknown

Unknown







Frequency of attendance at self-help programs in past 30 days prior to admission

~~~

K = Key Field



97

01

02

03

04

05

06


CWMS_PROXY

Crosswalk Report

of 67

New JerseyDischarge/NOMS

1

2

3

4

5

6

System Transaction at Discharge

State Code at Discharge

Reporting Date at Discharge

State Provider Identifer at Discharge

Client Identifier at Discharge

Co-Dependent/Collateral at Discharge

A

C

D

-

-

1

2

Add

Change

Delete

NJ


Alcohol/Drug Abuser

Co-Dependent/Family

Add

Change

Delete

State abreviation according postal codes

No

No

Yes


FIPS State Code

Month and year data file submitted

Provider ID



~

NJ

~

~~

~~

~~

K = Key Field



A

C

D

-

2

2

1

MMYYYY

"NJ" + 6 characters



CWMS_PROXY

Crosswalk Report

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7

8

Type of Treatment Service/Treatment Setting at Discharge

Date of Last Contact or Data Update

1

10

11

12

13

14

15

2

3

4

5

6

7

8

9

Standard/Traditional Outpatient










Halfway House





Ambulatory -Non Intensive -Outpatient

Detoxification, 24-Hour Service, Hospital Inpatient





Ambulatory - Intensive -Outpatient

Ambulatory - Intensive -Outpatient

Rehabilation/Residential - Hospital (other than detoxification)

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



Rehabilation/Residential - Short Term (30 Daysor Fewer)

Rehabilation/Residential - Hospital (other than detoxification)

Detoxification, 24-Hour Service, Free Standing Residential

Level of Care ( Admission and Discharge)

Date of Last Contact

~~

~~~~

K = Key Field



07

01

08

07

08

07

06

06

03

05

05

05

04

03

02

MMDDYYYY


CWMS_PROXY

Crosswalk Report

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9

10

Date of Discharge

Reason for Discharge, Transfer, or Discontinuance of Treatment

-

-

-

-

-

-

-

-

-

-

n/a - not collected by state

Treament plan completed

Quit or dropped out

Administrative Discharge/Rule Non-compliance

Unknown ( None of the other options)


Incarcerated

Deceased

Other

Medical Discharge/Hospitalized

Transferred to anoither treatment program or facility that is not inSSA or SMHA

Treatment Completed

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

Ternimated by Facility

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

Transferred to Trtment Prog or Facil, but did notreport

Incarerated or released by or to courts

Death

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

Transferred to Another Treatment Program or Facility

Date of Discharge

Reason for Discharge

~~~~

~~~~

K = Key Field



24

01

02

03

08

14

05

06

07

04

MMDDYYYY


CWMS_PROXY

Crosswalk Report

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10

11

12

Reason for Discharge, Transfer, or Discontinuance of Treatment

Provider Identifier at Admission

Client Identifier at Admission

-

-

-

-

-

-

-

-

-

Treament plan completed

Quit or dropped out

Administrative Discharge/Rule Non-compliance

Medical Discharge/Hospitalized

Unknown ( None of the other options)

Incarcerated

Deceased

Other


Treatment Completed

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

Ternimated by Facility

Transferred to Another Treatment Program or Facility

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

Incarerated or released by or to courts

Death

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

Transferred to Trtment Prog or Facil, but did notreport

Reason for Discharge

Provider ID


~~~~

~~

~~

K = Key Field



01

02

03

04

08

05

06

07

14


"NJ" + 6 characters



CWMS_PROXY

Crosswalk Report

of 67


13

14

15

Co-Depentent/Collateral at Admission

Client Transaction Type (pulled from admission dataset)

Date of Admission (pulled from admission dataset)

-

1

2

A

T


Alcohol/Drug Abuser

Co-Dependent/Family

Admission

Transfer

Client

Client

Codependent/collateral

Initial Admission (SA)

Transfer or change in service (SA)



Date of Admission

~~

~~

~~

K = Key Field



2

2

1

A

T

MMDDYYYY Format


CWMS_PROXY

Crosswalk Report

of 67


16

17

Type of Service at Admission (pulled from admission dataset)

Date of Birth (pulled from admission dataset)

10

11

12

13

14

15

2

3

4

5

6

7

7

8

9










Halfway House






Detoxification, 24-hour service - Hospital Inpatient








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




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

Rehabilitation/Residential - Hospital (other thanDetoxification)

Detoxification , 24 hour service , Free-StandingResidential

Level of Care ( Admission and Discharge)

DOB

~~

~~

K = Key Field



01

08

07

08

07

06

06

06

05

05

05

07

04

03

02

mmddyyyy


CWMS_PROXY

Crosswalk Report

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18

19

Gender (pulled from admission dataset)

Race (pulled from admission dataset)

-

1

2

3

4

-

1

2

3

4

5

6


Male

Female

Transgender

Other


White

Black

Asian

Alaskan Native

American Indian


Unknown

Male

Female

Unknown

Unknown

Unknown

White


Asian

Alaskan Native (Aleut, Eskimo)

American Indian


Gender

Race

~~

~~

K = Key Field



7

1

2

7

7

97

05

04

13

01

02

23



CWMS_PROXY

Crosswalk Report

of 67


19

20

Race (pulled from admission dataset)

Ethnicity (pulled from admission dataset)

-

-

-

1

2

3

4

5

6

-

1

2

3

4

5

6

if Race2 has value between and 6 inclusive and equal to Race1

n/a


White

Black

Asian

Alaskan Native

American Indian



Not of Hispanic Orgin

Puerto Rican

Mexican

Cuban

Dominican

Other Hispanic

Two or more races

Other single race

Unknown

White


Asian

Alaskan Native (Aleut, Eskimo)

American Indian


Unknown

Not of Specific Hispanic or Latino Origin

Puerto Rican

Mexican

Cuban

Other Specific Hispanic or Latino

Hispanic or Latino - specific origin not specified

Race

Ethnicity

~~

~~

K = Key Field



21

20

97

05

04

13

01

02

23

97

05

01

02

03

04

06


CWMS_PROXY

Crosswalk Report

of 67

New JerseyDischarge/NOMSK = Key Field




CWMS_PROXY

Crosswalk Report

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

-

1

10

11

12

13

14

15

16

17

18

19

2

20

21

22

3

4


Alcohol

GHB

Hallucingens - LSD

Hallucingens - PCP


Inhalants

Ketamine


Opiate - Other

Oxycontin

Rohypnol

Heroin


None

Other Amphetamines

Marijuana/Hashish

Cocaine - Powder

Unknown

Alcohol

Other

Hallucinogens

PCP- phencyclidine

Hallucinogens

Inhalants

Other




Benzodiazepines

Heroin

Other

None

Other Amphetamines

Marijuana/Hashish

Cocaine/Crack


K = Key Field



97

02

20

09

08

09

17

20

06

07

07

13

05

20

01

11

04

03


CWMS_PROXY

Crosswalk Report

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5

6

7

8

9

Crack


Barbiturates

Benzodiazepines


Cocaine/Crack

Methampetamine/SPeed

Barbiturates

Benzodiazepines

Other Amphetamines


K = Key Field



03

10

15

13

11



CWMS_PROXY

Crosswalk Report

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-

-

-

-

1

10

11

12

13

14

15

16

17

18

19

2

20

21


n/a

n/a

n/a

Alcohol

GHB

Hallucingens - LSD

Hallucingens - PCP


Inhalants

Ketamine


Opiate - Other

Oxycontin

Rohypnol

Heroin


None

Unknown

Other Sedatives or Hypontics

Over-The-Counter medicines

Other Tranquilizer

Alcohol

Other

Hallucinogens

PCP- phencyclidine

Hallucinogens

Inhalants

Other




Benzodiazepines

Heroin

Other

None


K = Key Field



97

16

18

14

02

20

09

08

09

17

20

06

07

07

13

05

20

01


CWMS_PROXY

Crosswalk Report

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22

23

24

25

26

27

28

29

3

30

31

32

33

34

35

36

37

38

Other Amphetamines


Codeine




Pentazocine


Marijuana/Hashish

Tramadol (Ultram)


Alprazolam (Xanax)



Diazepam (Valium)


Lorazepam (Ativan)


Other Amphetamines








Marijuana/Hashish


Other Stimulants

Benzodiazepines

Benzodiazepines

Benzodiazepines

Benzodiazepines

Benzodiazepines

Benzodiazepines

Other


K = Key Field



11

07

07

07

07

07

07

07

04

07

12

13

13

13

13

13

13

20


CWMS_PROXY

Crosswalk Report

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21

22

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

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

39

4

5

6

7

8

9

-

1

2

3

4

5

Bath Salts

Cocaine - Powder

Crack


Barbiturates

Benzodiazepines



No use past month

Less than weekly



Daily

Other Amphetamines

Cocaine/Crack

Cocaine/Crack

Methampetamine/SPeed

Barbiturates

Benzodiazepines

Other Amphetamines

Unknown

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



~~

~~

K = Key Field



11

03

03

10

15

13

11

97

01

02

03

04

05


CWMS_PROXY

Crosswalk Report

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23

23

Living Arrangements at Discharge

Living Arrangements at Discharge

-

1

2

3

4

-

1

2

3

4


Homeless - Shelter

Homeless - Streets


Independent Living



Homeless - Shelter

Homeless - Streets

Independent Living

Unknown





Unknown







~~~

~~~

K = Key Field



97

01

01

02

03

97

02

01

01

03



CWMS_PROXY

Crosswalk Report

of 67


24 Employment at Discharge

-

1

10

11

2

3

4

5

6

7

8

9




Disabled


Part-Time (Not Regular Hours)

Student

Homemaker

Retired




Unknown













K = Key Field



97

01

04

04

02

02

04

04

04

03

04

03



CWMS_PROXY

Crosswalk Report

of 67


24 Employment at Discharge

-

1

10

2

3

4

5

6

7

8

9



Disabled


Student

Homemaker

Retired





Unknown












K = Key Field



97

01

04

02

04

04

04

03

04

04

04


CWMS_PROXY

Crosswalk Report

of 67


25

25

Detailed Not In Labor Force at Discharge

Detailed Not In Labor Force at Discharge

-

10

11

4

5

6

8

-

10

3

4

5

7

9



Disabled

Student

Homemaker

Retired



Disabled

Student

Homemaker

Retired



Unknown


Disabled

Student

Homemaker

Retired

Other

Unknown

Disabled

Student

Homemaker

Retired

Other




~~

~~

K = Key Field



97

05

04

02

01

03

06

97

04

02

01

03

06

05



CWMS_PROXY

Crosswalk Report

of 67


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

-

0-96

-

1

2

3

4

5

6


Arrest(s)


No attendance in the past month





Some attendance in past month, but frequency unknown

Unknown

Number of Arrests

Unknown







Number of Arrests in 30 Days Prior to Discharge

Not Collected

Frequency of attendance at self-help programs in 30 days prior to Discharge

~~~~

~~~

~~~~

K = Key Field



97

00-96

97

01

02

03

04

05

06



REPORT CROSSWALK TO STATE

Crosswalk Management System

End of Report

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