F.1   Data Collection Requirements:

  1. Center must maintain an electronic data collection system that is compatible with the state collection system and has the capacity to collect the required variables listed below. Compatibility means the system can export required variables along with dictionary files in a useable format.

F.2   Data Variable Requirements:

  1. Certain data variables shall be collected at each encountered visit including:
    • Unique patient identifier (not name)
    • Date of birth
    • Gender
    • Race (as defined by state TAO)
    • Grade (grade & student status codes as defined)
    • Insurance status (as defined by state TAO, but to include at a minimum the following categories: public, private, none, unknown)
    • Date of visit
    • Location of visit (site identification)
    • Provider type (as defined by state TAO)
    • CPT visit code(s)
    • Visit time units
    • Diagnostic code(s) (ICD-9 or 10, DSM IV)
    • Selected risk factor status (see guidance, F.4.a)

F.3   Data Reporting Requirements:

  1. Data shall be reported to the state TAO on an annual basis. A mid-year preliminary report may be requested by the state as a means of monitoring sites’ data collection operations and to provide technical assistance if problems are noted.

F.4   Risk Factor Guidance:

  1. Information about the following selected risk factors may be required at least annually on each patient: tobacco, alcohol, sexual activity, and immunization status. For patients with an identified risk factor, additional data elements may be collected at each encountered visit.1

1Implementation anticipated in service year ’00-’01. Further guidance to follow at a later date.