Scenario 7: Client referred » client assessed » eligible for service in OSP » most appropriate for treatment offered at Assessment NLO » begins/ completes treatment » receives treatment session(s) for new main problem descriptor » exits OSP
| Stage | Element | Response Option Cells in yellow represent specific response options for a scenario. Fields in grey with ‘--‘ should be left blank because they are not applicable to the listed scenario. |
| 1. Referral Received | Hub/ Network Lead Organization | 100, 200, 300, 400, 600, 800, 900, 1000, 1100, 1300 |
| Date referral received | YYYYMMDD | |
| OHIP # | Number | |
| Referral Source Type | 1-8, 77 | |
| OHIP billing number | Number | |
| PHQ 9 referral score | Score | |
| GAD 7 referral score | Score | |
| 2. Referral Completed | Date referral completed | YYYYMMDD |
| Referral Type | 1 | |
| OHIP # (if not collected prior) | Number | |
| Unique Client ID | Number | |
| Client/Patient First Name | As written | |
| Client/Patient Last Name | As written | |
| Address | As written | |
| City | As written | |
| Postal Code | As written, NFA, UNK, FSA | |
| Service Request ID- Incoming | -- | |
| 3. Initial Screen/ Screen for Eligibility | Screening for eligibility date | YYYYMMDD |
| Outcome of eligibility screen | 1 | |
| 4. Clinical Intake and Triage Assessment | Date of Birth | YYYYMMDD |
| Francophone | 1-2, 88, 99 | |
| Requires French language services | 1-2 | |
| Main spoken language | 1-35, 77, 88, 99 | |
| Main spoken language – Other | As written | |
| Interpreter required | 1-2 | |
| Gender | 1-7, 77, 88, 99 | |
| Sexual Orientation | 1-6, 77, 88, 99 | |
| Racial/ethnic group | 1-8, 10-16, 77, 88, 99 | |
| Work status | 1-6, 77, 88, 99 | |
| Student status | 1-3, 77, 88, 99 | |
| Client has less than 5 years in Canada | 1-2, 88, 99 | |
| Was client born in Canada? | 1-2, 88, 99 | |
| If no, what year did client arrive in Canada? | YYYY | |
| Family income | 1-8, 77, 88, 99 | |
| How many people does this income support? | Number | |
| Health status | 1-8, 77, 88, 99 | |
| Prior mental health counselling | 1-2, 88, 99 | |
| Session date | YYYYMMDD | |
| Session type | 1 | |
| Session attendance | 1-5 | |
| Duration of session | Number | |
| Provider ID | Number | |
| Triage service recommendation | 1 | |
| Reason for triage decision | 1-13 | |
| PHQ-9 score (ASSESSMENT) | Score | |
| GAD-7 score (ASSESSMENT) | Score | |
| WHODAS score (ASSESSMENT) | Score | |
| HAI-SW scale score (ASSESSMENT) | Score | |
| OCI-R scale score (ASSESSMENT) | Score | |
| PDSS-SR scale score (ASSESSMENT) | Score | |
| PCL-5 scale score (ASSESSMENT) | Score | |
| SPIN scale score (ASSESSMENT) | Score | |
| Severity Measure for Specific Phobia- Adult Scale score | Score | |
| (ASSESSMENT) | ||
| AUDIT-C score (ASSESSMENT) | Score | |
| DUDIT score (ASSESSMENT) | Score | |
| PSWQ scale score (ASSESSMENT) | Score | |
| Main Problem descriptor (ASSESSMENT) | 2-5, 7-11 | |
| 5. Enrollment | OSP Program enrollment date | YYYYMMDD |
| 6. Service/Treatment (for primary Main Problem Descriptor) | Service Delivery Site | Site Number |
| Treatment start date | YYYYMMDD | |
| Session date | YYYYMMDD | |
| Session type | 2, 3 (Last session type of planned treatment for this problem descriptor=3) | |
| Session attendance | 1-5 | |
| Duration of session | Number | |
| Provider ID | Number | |
| OSP Program Service | 1-6 | |
| Service Delivery Type | 1-7, 77 | |
| Linguistic/ culturally specific service | 1-5, 77 | |
| PHQ-9 score (TREATMENT) | Score | |
| GAD-7 score (TREATMENT) | Score | |
| WHODAS score (TREATMENT) | Score | |
| WSAS score (TREATMENT) | Score | |
| HAI-SW scale score (TREATMENT) | Score | |
| OCI-R scale score (TREATMENT) | Score | |
| PDSS-SR scale score (TREATMENT) | Score | |
| PCL-5 scale score (TREATMENT) | Score | |
| SPIN scale score (TREATMENT) | Score | |
| Severity Measure for Specific Phobia- Adult | Score | |
| Scale score (TREATMENT) | ||
| AUDIT-C score (TREATMENT) | Score | |
| DUDIT score (TREATMENT) | Score | |
| PSWQ scale score (TREATMENT) | Score | |
| Main Problem descriptor (TREATMENT) | 2-5, 7-11 | |
| Treatment completion date | YYYYMMDD (leave blank if treatment is not completed for primary main problem descriptor | |
| 7. Additional Treatment Sessions (for secondary Main Problem Descriptor) | Service Delivery Site | Site Number |
| Session date | YYYYMMDD | |
| Session type | 2,3 (Last session type of planned treatment for this problem descriptor=3) | |
| Session attendance | 1-5 | |
| Duration of session | Number | |
| Provider ID | Number | |
| OSP Program Service | 1-6 | |
| Service Delivery Type | 1-7, 77 | |
| Linguistic/ culturally specific service | 1-5, 77 | |
| PHQ-9 score (TREATMENT) | Score | |
| GAD-7 score (TREATMENT) | Score | |
| WHODAS score (TREATMENT) | Score | |
| WSAS score (TREATMENT) | Score | |
| HAI-SW scale score (TREATMENT) | Score | |
| OCI-R scale score (TREATMENT) | Score | |
| PDSS-SR scale score (TREATMENT) | Score | |
| PCL-5 scale score (TREATMENT) | Score | |
| SPIN scale score (TREATMENT) | Score | |
| Severity Measure for Specific Phobia- Adult | Score | |
| Scale score (TREATMENT) | ||
| AUDIT-C score (TREATMENT) | Score | |
| DUDIT score (TREATMENT) | Score | |
| PSWQ scale score (TREATMENT) | Score | |
| Main Problem descriptor (TREATMENT) | 2-5, 7-11 (Differs from Section 6) | |
| Treatment completion date | N/A (entered at end of planned treatment for primary Main Problem Descriptor) | |
| 8. Client Hold | Type of client hold | -- |
| Stage of client hold | -- | |
| Client hold start date | -- | |
| Client hold end date | -- | |
| 9. Client Exit/ Not Accepted to Program/ Service Request Outgoing | Exit date | YYYYMMDD |
| Stage of client exit or referral | 3 | |
| Exit disposition | 1 | |
| Ineligible due to: | -- | |
| Where was referral/service request made? | -- | |
| Date referral/service request was made | -- | |
| Service Request ID- Outgoing | -- |
