OSP Stepped Care Service Request - Required Data Elements
Data Element Required for sending Service Request/ Client Transfer (at Triage or Step Up) |
4. Referral Type |
7. OHIP # |
OHIP Version Code |
9. Client First Name |
10. Client Last Name |
Client's Preferred Name |
11. Address |
12. City |
13. Postal Code |
Client Telephone Number (Home/Mobile) |
Client Email Address |
14. Referral Source Type |
15. OHIP billing # |
16. PHQ9 referral score |
17. GAD7 referral score |
20. Date of Birth |
23. Main language spoken |
Preferred Language for Coaching Service |
25. Interpreter required |
26. Gender |
28. Racial/ ethnic group |
42. Triage Assessment -Service recommendation |
43. Triage Assessment - Reason for decision |
55. Main problem descriptor |
56. OSP enrollment date |
87. Service Request ID- Outgoing |
Mailing Info (Purolator/Canada Post) |
Narrative /Reason for transfer and recommended treatment |
CMHA BB Risk Report (treatment history/assessment scores) or HUB Clinician Risk Report (treatment history/assessment scores) |
Primary Care Provider contact information |
|
PHQ9 score |
GAD7 score |
WHODAS score |
SHAI scale score (if administered) |
OCI-R scale score (if administered) |
PDSS-SR scale score (if administered) |
PCL-5 scale score (if administered) |
SPIN scale score (if administered) |
AUDIT-C score (if administered) |
DUDIT score (if administered) |
PSWQ scale score (if administered) |
Note: New OSP MDS elements (OSP MDS v1.13, April 2021), Non-MDS elements
