For Office Use Only DL# HREC# Version Date Mental Health Ambulatory Data Please click here to select group Every request for mental health data will be evaluated separately on its merit by the Data Custodian. To prevent potential delays it is strongly recommended applicants spend time discussing their needs with the Data Custodian before submitting an application for data. See the contacts at: http://www.health.wa.gov.au/healthdata/contact/index.cfm Please note that all requests for mental health data require DOHWA HREC approval. Request variables below by checking boxes Request Variable Patient Information Gender Indigenous status Country of birth Subset Date of Birth Subset Date of Birth Age on contact Marital status Health service of residency Occupation Employment status Education status Postcode Service event data Primary diagnosis code Primary diagnosis ICD System Time of contact Duration of contact Stream type Contact type Venue of contact Patient present at contact Medium of contact Description Aboriginal or Torres Strait Islander MMYYYY YYYY At time of admission At time of admission Level of education reached at time of admission Primary diagnosis code for episode as at contact date. The ICD version used to code Primary Diagnosis Time of day when contact began Length of time for service event Child & Adolescent, Adult, Seniors Clinical, client related, liaison etc Clinic, private home, hospital etc Patient present or not at contact Face to face, phone, video link Treatment completed, referred to another service, client Outcome of episode did not attend etc. Only available on completed episodes. Standard Mental Health Variables (released on all extracts of Mental Health data) EPSEQ Episode Sequence Number Subset Date of contact MMYYYY MMYYYY Subset Episode start date Start date of episode (also called referral date) MMYYYY Subset Episode end date End date of episode (also called discharge date) Group of Non Group flag of contact Indicator of a group of single patient contact Source of data FORMS, LAMHIS, PSOLIS Last updated 17 January 2017 Module 3 Variable Lists 1 Sensitive Variables All of the variables below have been determined as sensitive by the Mental Health Data Custodian and therefore require written justification. Please provide this in the space in the table below. All items require DOHWA HREC approval. Hospital Establishment codes and units of contact are considered identifying information, especially if they involve private establishments. Provision of these codes requires DOHWA HREC approval and/or hospital ethics approval. Approval from the Chief Executive of the area health service may also be required. Request Variable Description Full date of birth DDMMYYYY Enter justification here Suburb Suburb of residence Enter justification here Unit of contact Approval from AHS may be required Enter justification here Date of contact with Ambulatory service DDMMYYYY Full date of contact Enter justification here Legal status Mental health legal status Enter justification here Start date of episode (also called referral date) DDMMYYYY Full episode start date Enter justification here End date of episode (also called discharge date) DDMMYYYY Full episode end date Enter justification here Comments: Enter any extra comments here Last updated 17 January 2017 Module 3 Variable Lists 2
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