encounter_location
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Where did this encounter take place?, type: esriFieldTypeString
, Coded Values:
[emergency_dept: Emergency department]
, [inpatient_hospital: Inpatient hospital floor]
, [outpatient_clinic: Outpatient clinic]
, ...7 more...
)
encounter_location_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other location did this encounter take place?, type: esriFieldTypeString
)
encounter_type
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is this a follow-up encounter?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
outcome
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Please describe the outcome of the previous encounter including adherence to follow-up, barriers to follow-up (e.g., transportation, financial, childcare) or successful outcomes, etc., type: esriFieldTypeString
)
previous_referral
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Was this client previously given a referral?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
previous_referral_outcome
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Describe the result of the previous referral(s). Include information on the previous referrals, if the client completed those referrals, and if there is any further followup/action related to those referrals., type: esriFieldTypeString
)
mh_illness
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Does the client have a mental health illness?, type: esriFieldTypeString
, Coded Values:
[diagnosed: Diagnosed]
, [client_belief: Client-belief]
, [no: No]
, ...1 more...
)
mh_care
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the client receiving care for their mental health diagnosis?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [unsure: Unsure]
)
od_30day
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Has this individual experienced an overdose in the last 30 days?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [unsure: Unsure]
)
od_30day_n
(
nullable: true, editable: true, defaultValue: null, alias: How many overdoses has the individual experienced in the past 30 days?, type: esriFieldTypeInteger
)
tx_access
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Has the individual accessed treatment for their substance use in the last 30 days prior to this engagement?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [unsure: Unsure]
)
tx_access_none_reason
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Why has the client not accessed treatment for their substance use?, type: esriFieldTypeString
)
tx_received
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What treatment have they received? (select all that apply), type: esriFieldTypeString
)
tx_received_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other treatment have they received?, type: esriFieldTypeString
)
services
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What services did you provide during this encounter? (select all that apply), type: esriFieldTypeString
)
services_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other service(s) was/were provided?, type: esriFieldTypeString
)
services_none_reason
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Why were no services provided?, type: esriFieldTypeString
)
service_warmhandoff
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: To what provider was this client given a warm handoff?, type: esriFieldTypeString
)
hr_items
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What overdose prevention strategies did you provide? (select all that apply), type: esriFieldTypeString
)
hr_items_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other overdose prevention strategy was provided?, type: esriFieldTypeString
)
tracfone_enrolled
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the client already enrolled in the TracFone program?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
tracfone_used
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did the client use the phone since their previous encounter?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
tracfone_use
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What did the client use the phone for? (Select all that apply), type: esriFieldTypeString
)
tracfone_use_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other purpose was the phone used for?, type: esriFieldTypeString
)
tracfone_issue
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did the client experience any issues using the phone? (Select all that apply), type: esriFieldTypeString
)
tracfone_issue_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other issue was experienced?, type: esriFieldTypeString
)
tracfone_continue
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the client interested in having the phone for another month?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [unsure: Unsure]
)
tracfone_discussed
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did you have a discussion with this client about the TracFone program?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
tracfone_dist
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did the client receive a phone?, type: esriFieldTypeString
, Coded Values:
[yes: Yes, a phone was distributed]
, [declined: No, the client declined]
, [none_available: No, a phone was not available or other inventory issue]
, ...1 more...
)
tracfone_dist_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Why did the client not receive a phone?, type: esriFieldTypeString
)
tracfone_number
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Enter the phone number printed on the packaging. The recipient will receive a follow-up survey as part of the TracFone program., type: esriFieldTypeString
)
tracfone_language
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the client's primary language?, type: esriFieldTypeString
, Coded Values:
[english: English]
, [other: Other]
)
tracfone_coverage_issue
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are there any foreseeable issues with cell service coverage for this client?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
tracfone_coverage_issue_text
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please describe the service coverage concern., type: esriFieldTypeString
)
tracfone_special_needs
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Does this client have special needs related to phone use? (e.g., vision or hearing impairment, limited literacy, unfamiliar with smartphones), type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
tracfone_special_needs_text
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please describe the special needs., type: esriFieldTypeString
)
tracfone_charging_issue
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are there anticipated issues to phone charging for this client?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
tracfone_process_working
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: How is the phone distribution process working from your perspective? What is going well and what challenges have you encountered?, type: esriFieldTypeString
)
tracfone_comments
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Do you have any additional comments, suggestions, or concerns about the TracFone program?, type: esriFieldTypeString
)
referral_made
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did you give a referral?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
referral_no_reason
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Why was no referral given? (Select all that apply), type: esriFieldTypeString
)
referral_no_reason_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other reason was no referral given?, type: esriFieldTypeString
)
referrals
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What referrals did you give during this encounter? (select all that apply), type: esriFieldTypeString
)
referrals_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other referrals were given?, type: esriFieldTypeString
)
housing_90day
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What was the client's housing status during the last 90 days? (select all that apply), type: esriFieldTypeString
)
housing_90day_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What other housing status did the client have?, type: esriFieldTypeString
)
zip
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the client's residential zip code?, type: esriFieldTypeString
)
town
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the current residential township or borough of the client?, type: esriFieldTypeString
, Coded Values:
[outside_county: Outside of Montgomery County]
, [unhoused: Unhoused]
, [abington_township: Abington Township]
, ...65 more...
)
age
(
nullable: true, editable: true, defaultValue: null, alias: What is the client's current age?, type: esriFieldTypeInteger
)
sex
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the client's sex at birth?, type: esriFieldTypeString
, Coded Values:
[female: Female]
, [male: Male]
, [intersex: Intersex]
, ...2 more...
)
sex_other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Self-described sex at birth:, type: esriFieldTypeString
)
race
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is client's race/ethnicity? (select all that apply), type: esriFieldTypeString
)
insurance
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What insurance does the client have? (select all that apply), type: esriFieldTypeString
)
justice_90day
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Has the client been involved with the justice system in the past 90 days?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [unsure: Unsure]
)
enc_duration
(
nullable: true, editable: true, defaultValue: null, alias: Estimate the time spent on this encounter in minutes., type: esriFieldTypeInteger
)
followup_contact
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the client willing to be contacted by OD2A partners for follow-up purposes?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
detail_success
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Please provide details below regarding the successes you'd like to highlight., type: esriFieldTypeString
)
detail_barrier
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Please provide details below regarding the barriers you'd like to highlight., type: esriFieldTypeString
)
detail_other
(
nullable: true, editable: true, defaultValue: null, length: 3000, alias: Please specify any additional information you would like to share concerning this case., type: esriFieldTypeString
)
tracfone_followup_period
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please followup with the client 14 days after they've received the phone., type: esriFieldTypeString
)