Clt17 Disabilities The client’s physical, No Multiple Enumeration 1 = ambulatory difficulty (code) 2 = cognitive difficulty emotional, and mental health 3 = communication issues that result in limitation difficulty in activities and restrictions to 4 = hearing difficulty fully participate at school, 5 = independent living work, or in the community. difficulty Multiple disability code values 6 = self-care difficulty can be submitted for the 7 = vision difficulty client. 8 = other 9 = none Clt18 ADL score The client’s score on the Katz No Single Numeric Permissible values are (6 integers) 0-6 Index of Independence in Activities of Daily Living (ADL). Clt19 IADL score The client’s score on the No Single Numeric Permissible values are (6 integers) 0-8 Lawton Instrumental Activities of Daily Living (IADL). Clt20 Behavioral The results of assessments No Multiple Enumeration 1 = alcohol use disorder (code) 2 = anxiety health on the client, conducted by 3 = bipolar disorder screenings or the APS agency. Multiple 4 = dementia diagnoses behavioral health code values 5 = depression can be submitted for the 6 = schizophrenia and client. other psychotic disorders 7 = substance use disorder 8 = traumatic brain injury 9 = other 10 = none Living setting at The primary residential No Single Enumeration 10 = own residence or (code) residence of relative or start environment of the client at caregiver the start of investigation. 20 = residential care community (non-specific) 21 = licensed residential care community 22 = non-licensed residential care community 30 = nursing home 31 = licensed nursing home 32 = non-licensed nursing home 40 = other
Clt17 Disabilities The client’s physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disability code values can be submitted for the client. No Multiple Enumeration (code) 1 = ambulatory difficulty 2 = cognitive difficulty 3 = communication difficulty 4 = hearing difficulty 5 = independent living difficulty 6 = self-care difficulty 7 = vision difficulty 8 = other 9 = none Clt18 ADL score The client’s score on the Katz Index of Independence in Activities of Daily Living (ADL). No Single Numeric (6 integers) Permissible values are 0-6 Clt19 IADL score The client’s score on the Lawton Instrumental Activities of Daily Living (IADL). No Single Numeric (6 integers) Permissible values are 0-8 Clt20 Behavioral health screenings or diagnoses The results of assessments on the client, conducted by the APS agency. Multiple behavioral health code values can be submitted for the client. No Multiple Enumeration (code) 1 = alcohol use disorder 2 = anxiety 3 = bipolar disorder 4 = dementia 5 = depression 6 = schizophrenia and other psychotic disorders 7 = substance use disorder 8 = traumatic brain injury 9 = other 10 = none Living setting at start The primary residential environment of the client at the start of investigation. No Single Enumeration (code) 10 = own residence or residence of relative or caregiver 20 = residential care community (non-specific) 21 = licensed residential care community 22 = non-licensed residential care community 30 = nursing home 31 = licensed nursing home 32 = non-licensed nursing home 40 = other
NAMRSCaseDataSpecsOMB2017.docx