1.5.3 - release
SHINNYHRSN - Local Development build (v1.5.3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Active as of 2025-07-23 |
{
"resourceType" : "CodeSystem",
"id" : "SHINNYQuestionnaires",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem SHINNYQuestionnaires</b></p><a name=\"SHINNYQuestionnaires\"> </a><a name=\"hcSHINNYQuestionnaires\"> </a><a name=\"SHINNYQuestionnaires-en-US\"> </a><p>This case-sensitive code system <code>http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">assessment-approval-questionnaire<a name=\"SHINNYQuestionnaires-assessment-approval-questionnaire\"> </a></td><td>Assessment Approval Questionnaire</td><td>Patient approval to move forward with completing the assessment.</td></tr><tr><td style=\"white-space:nowrap\">assessment-outreach-questionnaire<a name=\"SHINNYQuestionnaires-assessment-outreach-questionnaire\"> </a></td><td>Assessment Outreach Questionnaire</td><td>Information regarding the patient outreach from the SCN for a patient assessment.</td></tr><tr><td style=\"white-space:nowrap\">administrative-questionnaire<a name=\"SHINNYQuestionnaires-administrative-questionnaire\"> </a></td><td>Administrative Questionnaire</td><td>Administrative questions that capture information about the patient's population categorization, specific services needed and/or medical necessities.</td></tr><tr><td style=\"white-space:nowrap\">service-duplication-questionnaire<a name=\"SHINNYQuestionnaires-service-duplication-questionnaire\"> </a></td><td>Service Duplication Questionnaire</td><td>Indicator questions recording whether the patient receives assistance from a variety of programs, as well as other social and healthcare needs.</td></tr><tr><td style=\"white-space:nowrap\">referral-approval-questionnaire<a name=\"SHINNYQuestionnaires-referral-approval-questionnaire\"> </a></td><td>Referral Approval Questionnaire</td><td>Patient approval to move forward with the referral.</td></tr><tr><td style=\"white-space:nowrap\">hrsn-outreach-questionnaire<a name=\"SHINNYQuestionnaires-hrsn-outreach-questionnaire\"> </a></td><td>HRSN Outreach Questionnaire</td><td>Captures the service provider outreach date.</td></tr><tr><td style=\"white-space:nowrap\">scn-outreach-questionnaire<a name=\"SHINNYQuestionnaires-scn-outreach-questionnaire\"> </a></td><td>SCN Outreach Questionnaire</td><td>Captures the service provider outreach date.</td></tr><tr><td style=\"white-space:nowrap\">disability-questionnaire<a name=\"SHINNYQuestionnaires-disability-questionnaire\"> </a></td><td>Disability Questionnaire</td><td>Captures responses about a patient's disability mobility.</td></tr><tr><td style=\"white-space:nowrap\">nys-hrsn-questionnaire<a name=\"SHINNYQuestionnaires-nys-hrsn-questionnaire\"> </a></td><td>NYS HRSN Questionnaire</td><td>NYS Accountable Health Communities (AHC) Health-Related Social Needs Screening (HRSN) tool</td></tr><tr><td style=\"white-space:nowrap\">patient-assessment-approval<a name=\"SHINNYQuestionnaires-patient-assessment-approval\"> </a></td><td>Patient Assessment Approval</td><td>Patient approval to move forward with completing the assessment.</td></tr><tr><td style=\"white-space:nowrap\">administrative-questions<a name=\"SHINNYQuestionnaires-administrative-questions\"> </a></td><td>Administrative Questions</td><td>Administrative questions that verify information about the patient.</td></tr><tr><td style=\"white-space:nowrap\">hrsn-outreach<a name=\"SHINNYQuestionnaires-hrsn-outreach\"> </a></td><td>HRSN Outreach</td><td>Questions regarding the HRSN outreach.</td></tr><tr><td style=\"white-space:nowrap\">assessment-outreach<a name=\"SHINNYQuestionnaires-assessment-outreach\"> </a></td><td>Assessment Outreach</td><td>Questions regarding the assessment outreach.</td></tr><tr><td style=\"white-space:nowrap\">referral-approval<a name=\"SHINNYQuestionnaires-referral-approval\"> </a></td><td>Referral Approval</td><td>Questions regarding the referral approval.</td></tr><tr><td style=\"white-space:nowrap\">scn-outreach<a name=\"SHINNYQuestionnaires-scn-outreach\"> </a></td><td>SCN Outreach</td><td>Questions regarding the SCN outreach.</td></tr><tr><td style=\"white-space:nowrap\">service-duplication-questions<a name=\"SHINNYQuestionnaires-service-duplication-questions\"> </a></td><td>Service Duplication Questions</td><td>Questions regarding service duplication.</td></tr><tr><td style=\"white-space:nowrap\">disability-questions<a name=\"SHINNYQuestionnaires-disability-questions\"> </a></td><td>Disability Questions</td><td>Captures a collection of screening responses about a patient's mobility and self-care.</td></tr><tr><td style=\"white-space:nowrap\">patient-assessment-approval-indicator<a name=\"SHINNYQuestionnaires-patient-assessment-approval-indicator\"> </a></td><td>Patient Assessment Approval Indicator</td><td>Indicator of whether the patient agreed to move forward with completing the assessment.</td></tr><tr><td style=\"white-space:nowrap\">patient-assessment-outreach-date<a name=\"SHINNYQuestionnaires-patient-assessment-outreach-date\"> </a></td><td>Patient Assessment Outreach Date</td><td>Date that a patient first receives outreach from SCN for assessment follow-up.</td></tr><tr><td style=\"white-space:nowrap\">patient-assessment-outreach-status<a name=\"SHINNYQuestionnaires-patient-assessment-outreach-status\"> </a></td><td>Patient Assessment Outreach Status</td><td>What was the final result of the patient assessment outreach? Did the patient get assessed? No response?</td></tr><tr><td style=\"white-space:nowrap\">outreach-method<a name=\"SHINNYQuestionnaires-outreach-method\"> </a></td><td>Outreach Method</td><td>Describes the method of contact used to reach out to the patient.</td></tr><tr><td style=\"white-space:nowrap\">enhanced-population-check<a name=\"SHINNYQuestionnaires-enhanced-population-check\"> </a></td><td>Enhanced Population Check</td><td>Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, resulting in SCN request to update covered population categorization with MCO.</td></tr><tr><td style=\"white-space:nowrap\">service-duplication-check<a name=\"SHINNYQuestionnaires-service-duplication-check\"> </a></td><td>Service Duplication Check</td><td>Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives services that would inhibit ability to deliver any or all NYHER services.</td></tr><tr><td style=\"white-space:nowrap\">clinical-criteria-check<a name=\"SHINNYQuestionnaires-clinical-criteria-check\"> </a></td><td>Clinical Criteria Check</td><td>Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient has the required medical necessity that would satisfy requirement to deliver NYHER service.</td></tr><tr><td style=\"white-space:nowrap\">housing-program<a name=\"SHINNYQuestionnaires-housing-program\"> </a></td><td>Housing Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives or is on any housing waitlists (e.g., HUD. Section 8, local housing authority, or other voucher programs).</td></tr><tr><td style=\"white-space:nowrap\">nutritional-education-program<a name=\"SHINNYQuestionnaires-nutritional-education-program\"> </a></td><td>Nutritional Education Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives nutritional counseling or education.</td></tr><tr><td style=\"white-space:nowrap\">nutritional-services-program<a name=\"SHINNYQuestionnaires-nutritional-services-program\"> </a></td><td>Nutritional Services Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is actively engaged in a nutrition program.</td></tr><tr><td style=\"white-space:nowrap\">food-service-program<a name=\"SHINNYQuestionnaires-food-service-program\"> </a></td><td>Food Service Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives any home-delivered meals or food services.</td></tr><tr><td style=\"white-space:nowrap\">snapp-program<a name=\"SHINNYQuestionnaires-snapp-program\"> </a></td><td>SNAPP Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in SNAP.</td></tr><tr><td style=\"white-space:nowrap\">wic-program<a name=\"SHINNYQuestionnaires-wic-program\"> </a></td><td>WIC Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in WIC.</td></tr><tr><td style=\"white-space:nowrap\">tanf-program<a name=\"SHINNYQuestionnaires-tanf-program\"> </a></td><td>TANF Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in TANF.</td></tr><tr><td style=\"white-space:nowrap\">transportation-program<a name=\"SHINNYQuestionnaires-transportation-program\"> </a></td><td>Transportation Program</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in Transportation services.</td></tr><tr><td style=\"white-space:nowrap\">medication-requiring-refrigeration<a name=\"SHINNYQuestionnaires-medication-requiring-refrigeration\"> </a></td><td>Medication Requiring Refrigeration</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently prescribed medication, requiring refrigeration for the management of a chronic condition.</td></tr><tr><td style=\"white-space:nowrap\">breast-milk-requiring-refrigeration<a name=\"SHINNYQuestionnaires-breast-milk-requiring-refrigeration\"> </a></td><td>Breast Milk Requiring Refrigeration</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is a pregnant/postpartum persons that require a refrigeration for breast milk.</td></tr><tr><td style=\"white-space:nowrap\">adls-iadls<a name=\"SHINNYQuestionnaires-adls-iadls\"> </a></td><td>ADLS-IADLS</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently has Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs) needs.</td></tr><tr><td style=\"white-space:nowrap\">medical-respite<a name=\"SHINNYQuestionnaires-medical-respite\"> </a></td><td>Medical Respite</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient meets the qualifications for medical respite (see notes).</td></tr><tr><td style=\"white-space:nowrap\">childcare-assistance<a name=\"SHINNYQuestionnaires-childcare-assistance\"> </a></td><td>Childcare Assistance</td><td>Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient needs assistance with childcare.</td></tr><tr><td style=\"white-space:nowrap\">patient-referral-approval<a name=\"SHINNYQuestionnaires-patient-referral-approval\"> </a></td><td>Patient Referral Approval</td><td>Patient approval to move forward with the referral.</td></tr><tr><td style=\"white-space:nowrap\">hrsn-referral-outreach-date<a name=\"SHINNYQuestionnaires-hrsn-referral-outreach-date\"> </a></td><td>HRSN Referral Outreach Date</td><td>The date/time the HRSN Service Provider conducted outreach to patient, based on accepted referral.</td></tr><tr><td style=\"white-space:nowrap\">scn-referral-outreach-date<a name=\"SHINNYQuestionnaires-scn-referral-outreach-date\"> </a></td><td>SCN Referral Outreach Date</td><td>The date/time the SCN conducted outreach to the patient, based on referral if outreach is not initiated by HRSN Service Provider/Social Service Provider.</td></tr><tr><td style=\"white-space:nowrap\">difficulty-walking-climbing-stairs<a name=\"SHINNYQuestionnaires-difficulty-walking-climbing-stairs\"> </a></td><td>Difficulty Walking Climbing Stairs</td><td>Do you have serious difficulty walking or climbing stairs? (5 years old or older)</td></tr><tr><td style=\"white-space:nowrap\">difficulty-dressing-bathing<a name=\"SHINNYQuestionnaires-difficulty-dressing-bathing\"> </a></td><td>Difficulty Dressing Bathing</td><td>Do you have difficulty dressing or bathing? (5 years old or older)</td></tr><tr><td style=\"white-space:nowrap\">medicaid-high-utilizer<a name=\"SHINNYQuestionnaires-medicaid-high-utilizer\"> </a></td><td>Medicaid High Utilizer</td><td/></tr><tr><td style=\"white-space:nowrap\">nys-health-home<a name=\"SHINNYQuestionnaires-nys-health-home\"> </a></td><td>Individuals Enrolled in a NYS Health Home</td><td/></tr><tr><td style=\"white-space:nowrap\">pregnant-postpartum<a name=\"SHINNYQuestionnaires-pregnant-postpartum\"> </a></td><td>Pregnant and Postpartum Persons</td><td/></tr><tr><td style=\"white-space:nowrap\">children-high-risk<a name=\"SHINNYQuestionnaires-children-high-risk\"> </a></td><td>High-Risk Children Under 18 Years Old</td><td/></tr><tr><td style=\"white-space:nowrap\">released-chronic-condition<a name=\"SHINNYQuestionnaires-released-chronic-condition\"> </a></td><td>Individuals with a Chronic Condition Released from Incarceration in the Past 90 Days</td><td/></tr><tr><td style=\"white-space:nowrap\">other-eligible-population<a name=\"SHINNYQuestionnaires-other-eligible-population\"> </a></td><td>Other Eligible Population</td><td/></tr><tr><td style=\"white-space:nowrap\">high-risk-nutrition<a name=\"SHINNYQuestionnaires-high-risk-nutrition\"> </a></td><td>High Risk Children Under 18 Nutrition Only</td><td/></tr><tr><td style=\"white-space:nowrap\">supportive-housing<a name=\"SHINNYQuestionnaires-supportive-housing\"> </a></td><td>Supportive Housing</td><td/></tr><tr><td style=\"white-space:nowrap\">healthy-homes<a name=\"SHINNYQuestionnaires-healthy-homes\"> </a></td><td>Healthy Homes</td><td/></tr><tr><td style=\"white-space:nowrap\">nutritional-counseling<a name=\"SHINNYQuestionnaires-nutritional-counseling\"> </a></td><td>Nutritional Counseling</td><td/></tr><tr><td style=\"white-space:nowrap\">medical-tailored-meals<a name=\"SHINNYQuestionnaires-medical-tailored-meals\"> </a></td><td>Medically Tailored Meals (MTM) In-lieu of Services (ILOS)</td><td/></tr><tr><td style=\"white-space:nowrap\">health-home-enrollment<a name=\"SHINNYQuestionnaires-health-home-enrollment\"> </a></td><td>Health Home Enrollment (under Enhanced Populations)</td><td/></tr><tr><td style=\"white-space:nowrap\">opwdd-waiver<a name=\"SHINNYQuestionnaires-opwdd-waiver\"> </a></td><td>Office for Persons with Developmental Disabilities (OPWDD) Waiver</td><td/></tr><tr><td style=\"white-space:nowrap\">tbi-waiver<a name=\"SHINNYQuestionnaires-tbi-waiver\"> </a></td><td>Traumatic Brain Injury (TBI) Waiver</td><td/></tr><tr><td style=\"white-space:nowrap\">nhtd-waiver<a name=\"SHINNYQuestionnaires-nhtd-waiver\"> </a></td><td>Nursing Home Transition Diversion (NHTD) Waiver</td><td/></tr><tr><td style=\"white-space:nowrap\">childrens-waiver<a name=\"SHINNYQuestionnaires-childrens-waiver\"> </a></td><td>Childrens Waiver</td><td/></tr><tr><td style=\"white-space:nowrap\">medicaid-advantage-program<a name=\"SHINNYQuestionnaires-medicaid-advantage-program\"> </a></td><td>Medicaid Advantage Program (MAP)</td><td/></tr><tr><td style=\"white-space:nowrap\">mltcp<a name=\"SHINNYQuestionnaires-mltcp\"> </a></td><td>Partial Capitation Managed Long-Term Care (MLTCP)</td><td/></tr><tr><td style=\"white-space:nowrap\">chronic-condition<a name=\"SHINNYQuestionnaires-chronic-condition\"> </a></td><td>Chronic Condition</td><td/></tr><tr><td style=\"white-space:nowrap\">uncontrolled-asthma<a name=\"SHINNYQuestionnaires-uncontrolled-asthma\"> </a></td><td>Uncontrolled Asthma</td><td/></tr><tr><td style=\"white-space:nowrap\">nutrition-therapy<a name=\"SHINNYQuestionnaires-nutrition-therapy\"> </a></td><td>Enteral or Parenteral Nutrition Therapy</td><td/></tr><tr><td style=\"white-space:nowrap\">current-institutional-setting<a name=\"SHINNYQuestionnaires-current-institutional-setting\"> </a></td><td>Currently in an Institutional Setting</td><td/></tr><tr><td style=\"white-space:nowrap\">heat-related-illness<a name=\"SHINNYQuestionnaires-heat-related-illness\"> </a></td><td>Heat-Related Illness Requiring an ER or UC Visit</td><td/></tr><tr><td style=\"white-space:nowrap\">cold-related-illness<a name=\"SHINNYQuestionnaires-cold-related-illness\"> </a></td><td>Cold-Related Illness Requiring an ER or UC Visit</td><td/></tr><tr><td style=\"white-space:nowrap\">thermoregulation-interference<a name=\"SHINNYQuestionnaires-thermoregulation-interference\"> </a></td><td>Conditions and Medications Interfering with Thermoregulation</td><td/></tr><tr><td style=\"white-space:nowrap\">none-of-the-above<a name=\"SHINNYQuestionnaires-none-of-the-above\"> </a></td><td>None of the Above</td><td/></tr><tr><td style=\"white-space:nowrap\">asked-declined<a name=\"SHINNYQuestionnaires-asked-declined\"> </a></td><td>Asked But Declined</td><td/></tr><tr><td style=\"white-space:nowrap\">phone<a name=\"SHINNYQuestionnaires-phone\"> </a></td><td>Phone</td><td/></tr><tr><td style=\"white-space:nowrap\">fax<a name=\"SHINNYQuestionnaires-fax\"> </a></td><td>Fax</td><td/></tr><tr><td style=\"white-space:nowrap\">email<a name=\"SHINNYQuestionnaires-email\"> </a></td><td>Email</td><td/></tr><tr><td style=\"white-space:nowrap\">pager<a name=\"SHINNYQuestionnaires-pager\"> </a></td><td>Pager</td><td/></tr><tr><td style=\"white-space:nowrap\">url<a name=\"SHINNYQuestionnaires-url\"> </a></td><td>URL</td><td/></tr><tr><td style=\"white-space:nowrap\">sms<a name=\"SHINNYQuestionnaires-sms\"> </a></td><td>SMS</td><td/></tr><tr><td style=\"white-space:nowrap\">other<a name=\"SHINNYQuestionnaires-other\"> </a></td><td>Other</td><td/></tr></table></div>"
},
"url" : "http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires",
"version" : "1.5.3",
"name" : "SHINNYQuestionnaires",
"title" : "SHINNY Questionnaires",
"status" : "active",
"experimental" : false,
"date" : "2025-07-23T17:01:14-04:00",
"publisher" : "shinny",
"contact" : [
{
"name" : "shinny",
"telecom" : [
{
"system" : "url",
"value" : "https://shinny.org/us/ny/hrsn/index.html"
}
]
}
],
"description" : "Codes for terms found in SHIN-NY Questionnaires",
"caseSensitive" : true,
"content" : "complete",
"count" : 76,
"concept" : [
{
"code" : "assessment-approval-questionnaire",
"display" : "Assessment Approval Questionnaire",
"definition" : "Patient approval to move forward with completing the assessment."
},
{
"code" : "assessment-outreach-questionnaire",
"display" : "Assessment Outreach Questionnaire",
"definition" : "Information regarding the patient outreach from the SCN for a patient assessment."
},
{
"code" : "administrative-questionnaire",
"display" : "Administrative Questionnaire",
"definition" : "Administrative questions that capture information about the patient's population categorization, specific services needed and/or medical necessities."
},
{
"code" : "service-duplication-questionnaire",
"display" : "Service Duplication Questionnaire",
"definition" : "Indicator questions recording whether the patient receives assistance from a variety of programs, as well as other social and healthcare needs."
},
{
"code" : "referral-approval-questionnaire",
"display" : "Referral Approval Questionnaire",
"definition" : "Patient approval to move forward with the referral."
},
{
"code" : "hrsn-outreach-questionnaire",
"display" : "HRSN Outreach Questionnaire",
"definition" : "Captures the service provider outreach date."
},
{
"code" : "scn-outreach-questionnaire",
"display" : "SCN Outreach Questionnaire",
"definition" : "Captures the service provider outreach date."
},
{
"code" : "disability-questionnaire",
"display" : "Disability Questionnaire",
"definition" : "Captures responses about a patient's disability mobility."
},
{
"code" : "nys-hrsn-questionnaire",
"display" : "NYS HRSN Questionnaire",
"definition" : "NYS Accountable Health Communities (AHC) Health-Related Social Needs Screening (HRSN) tool"
},
{
"code" : "patient-assessment-approval",
"display" : "Patient Assessment Approval",
"definition" : "Patient approval to move forward with completing the assessment."
},
{
"code" : "administrative-questions",
"display" : "Administrative Questions",
"definition" : "Administrative questions that verify information about the patient."
},
{
"code" : "hrsn-outreach",
"display" : "HRSN Outreach",
"definition" : "Questions regarding the HRSN outreach."
},
{
"code" : "assessment-outreach",
"display" : "Assessment Outreach",
"definition" : "Questions regarding the assessment outreach."
},
{
"code" : "referral-approval",
"display" : "Referral Approval",
"definition" : "Questions regarding the referral approval."
},
{
"code" : "scn-outreach",
"display" : "SCN Outreach",
"definition" : "Questions regarding the SCN outreach."
},
{
"code" : "service-duplication-questions",
"display" : "Service Duplication Questions",
"definition" : "Questions regarding service duplication."
},
{
"code" : "disability-questions",
"display" : "Disability Questions",
"definition" : "Captures a collection of screening responses about a patient's mobility and self-care."
},
{
"code" : "patient-assessment-approval-indicator",
"display" : "Patient Assessment Approval Indicator",
"definition" : "Indicator of whether the patient agreed to move forward with completing the assessment."
},
{
"code" : "patient-assessment-outreach-date",
"display" : "Patient Assessment Outreach Date",
"definition" : "Date that a patient first receives outreach from SCN for assessment follow-up."
},
{
"code" : "patient-assessment-outreach-status",
"display" : "Patient Assessment Outreach Status",
"definition" : "What was the final result of the patient assessment outreach? Did the patient get assessed? No response?"
},
{
"code" : "outreach-method",
"display" : "Outreach Method",
"definition" : "Describes the method of contact used to reach out to the patient."
},
{
"code" : "enhanced-population-check",
"display" : "Enhanced Population Check",
"definition" : "Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, resulting in SCN request to update covered population categorization with MCO."
},
{
"code" : "service-duplication-check",
"display" : "Service Duplication Check",
"definition" : "Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives services that would inhibit ability to deliver any or all NYHER services."
},
{
"code" : "clinical-criteria-check",
"display" : "Clinical Criteria Check",
"definition" : "Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient has the required medical necessity that would satisfy requirement to deliver NYHER service."
},
{
"code" : "housing-program",
"display" : "Housing Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives or is on any housing waitlists (e.g., HUD. Section 8, local housing authority, or other voucher programs)."
},
{
"code" : "nutritional-education-program",
"display" : "Nutritional Education Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives nutritional counseling or education."
},
{
"code" : "nutritional-services-program",
"display" : "Nutritional Services Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is actively engaged in a nutrition program."
},
{
"code" : "food-service-program",
"display" : "Food Service Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives any home-delivered meals or food services."
},
{
"code" : "snapp-program",
"display" : "SNAPP Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in SNAP."
},
{
"code" : "wic-program",
"display" : "WIC Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in WIC."
},
{
"code" : "tanf-program",
"display" : "TANF Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in TANF."
},
{
"code" : "transportation-program",
"display" : "Transportation Program",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in Transportation services."
},
{
"code" : "medication-requiring-refrigeration",
"display" : "Medication Requiring Refrigeration",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently prescribed medication, requiring refrigeration for the management of a chronic condition."
},
{
"code" : "breast-milk-requiring-refrigeration",
"display" : "Breast Milk Requiring Refrigeration",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is a pregnant/postpartum persons that require a refrigeration for breast milk."
},
{
"code" : "adls-iadls",
"display" : "ADLS-IADLS",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently has Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs) needs."
},
{
"code" : "medical-respite",
"display" : "Medical Respite",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient meets the qualifications for medical respite (see notes)."
},
{
"code" : "childcare-assistance",
"display" : "Childcare Assistance",
"definition" : "Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient needs assistance with childcare."
},
{
"code" : "patient-referral-approval",
"display" : "Patient Referral Approval",
"definition" : "Patient approval to move forward with the referral."
},
{
"code" : "hrsn-referral-outreach-date",
"display" : "HRSN Referral Outreach Date",
"definition" : "The date/time the HRSN Service Provider conducted outreach to patient, based on accepted referral."
},
{
"code" : "scn-referral-outreach-date",
"display" : "SCN Referral Outreach Date",
"definition" : "The date/time the SCN conducted outreach to the patient, based on referral if outreach is not initiated by HRSN Service Provider/Social Service Provider."
},
{
"code" : "difficulty-walking-climbing-stairs",
"display" : "Difficulty Walking Climbing Stairs",
"definition" : "Do you have serious difficulty walking or climbing stairs? (5 years old or older)"
},
{
"code" : "difficulty-dressing-bathing",
"display" : "Difficulty Dressing Bathing",
"definition" : "Do you have difficulty dressing or bathing? (5 years old or older)"
},
{
"code" : "medicaid-high-utilizer",
"display" : "Medicaid High Utilizer"
},
{
"code" : "nys-health-home",
"display" : "Individuals Enrolled in a NYS Health Home"
},
{
"code" : "pregnant-postpartum",
"display" : "Pregnant and Postpartum Persons"
},
{
"code" : "children-high-risk",
"display" : "High-Risk Children Under 18 Years Old"
},
{
"code" : "released-chronic-condition",
"display" : "Individuals with a Chronic Condition Released from Incarceration in the Past 90 Days"
},
{
"code" : "other-eligible-population",
"display" : "Other Eligible Population"
},
{
"code" : "high-risk-nutrition",
"display" : "High Risk Children Under 18 Nutrition Only"
},
{
"code" : "supportive-housing",
"display" : "Supportive Housing"
},
{
"code" : "healthy-homes",
"display" : "Healthy Homes"
},
{
"code" : "nutritional-counseling",
"display" : "Nutritional Counseling"
},
{
"code" : "medical-tailored-meals",
"display" : "Medically Tailored Meals (MTM) In-lieu of Services (ILOS)"
},
{
"code" : "health-home-enrollment",
"display" : "Health Home Enrollment (under Enhanced Populations)"
},
{
"code" : "opwdd-waiver",
"display" : "Office for Persons with Developmental Disabilities (OPWDD) Waiver"
},
{
"code" : "tbi-waiver",
"display" : "Traumatic Brain Injury (TBI) Waiver"
},
{
"code" : "nhtd-waiver",
"display" : "Nursing Home Transition Diversion (NHTD) Waiver"
},
{
"code" : "childrens-waiver",
"display" : "Childrens Waiver"
},
{
"code" : "medicaid-advantage-program",
"display" : "Medicaid Advantage Program (MAP)"
},
{
"code" : "mltcp",
"display" : "Partial Capitation Managed Long-Term Care (MLTCP)"
},
{
"code" : "chronic-condition",
"display" : "Chronic Condition"
},
{
"code" : "uncontrolled-asthma",
"display" : "Uncontrolled Asthma"
},
{
"code" : "nutrition-therapy",
"display" : "Enteral or Parenteral Nutrition Therapy"
},
{
"code" : "current-institutional-setting",
"display" : "Currently in an Institutional Setting"
},
{
"code" : "heat-related-illness",
"display" : "Heat-Related Illness Requiring an ER or UC Visit"
},
{
"code" : "cold-related-illness",
"display" : "Cold-Related Illness Requiring an ER or UC Visit"
},
{
"code" : "thermoregulation-interference",
"display" : "Conditions and Medications Interfering with Thermoregulation"
},
{
"code" : "none-of-the-above",
"display" : "None of the Above"
},
{
"code" : "asked-declined",
"display" : "Asked But Declined"
},
{
"code" : "phone",
"display" : "Phone"
},
{
"code" : "fax",
"display" : "Fax"
},
{
"code" : "email",
"display" : "Email"
},
{
"code" : "pager",
"display" : "Pager"
},
{
"code" : "url",
"display" : "URL"
},
{
"code" : "sms",
"display" : "SMS"
},
{
"code" : "other",
"display" : "Other"
}
]
}