| SPECIFICATION |
{"test":[{"content":[{"choice":[{"choiceId":5381,"choiceText":"No difficulites","ien":109060,"legacyValue":0,"sequence":1},{"choiceId":5382,"choiceText":"Mild difficulties (1-2 examples)","ien":109061,"legacyValue":1,"sequence":2},{"choiceI
esponseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":20},{"choice":[{"choiceId":5389,"choiceText":"No problems and satisfied with treatment and healthcare team","ien":109068,"legacyValue":0,"sequence":1},{"choiceId":
ment (CC&ICM) Complexity Assessment","publicationDate":2022,"publisher":null,"purpose":"To measure the level of care coordination complexity","reference":null,"requireSignature":true,"requiresLicense":"N","scoringRevision":1,"scoringRoutine
":null,"scoringTag":null,"staffOnly":"Y","submitNational":true,"suicideriskRoutine":null,"suicideriskTag":null,"targetPopulation":null,"version":"1.0","wasOperational":true},"report":{"id":300,"instrument":299,"template":"|Care Coordination
& Integrated Case Management (CC&ICM) Complexity Assessment (CCICM20)\r\n| \r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>
\r\n| Location: <.Location.>\r\n| \r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>\r\n| \r\n| CCICM20 Total Score = <-
CCICM20 TOTAL->\r\n| \r\n| \r\n|Questions and Answers:\r\n| \r\n| 1 Ability to communicate and understand healthcare needs to obtain services (e.g. providers, teams, medication and equipment)\r\n| <*Answer_8844*>\r\n| 2 Access
to healthcare within VA and\/or Community Care (e.g. geographical barriers, transportation, clinic availability and technology availability for virtual care)\r\n| <*Answer_8845*>\r\n| 3 Experience with providers and healthcare team\
r\n| <*Answer_8846*>\r\n| 4 Utilization\r\n| <*Answer_8847*>\r\n| 5 Shared Decision-Making\r\n| <*Answer_8848*>\r\n| 6 Readiness to change\r\n| <*Answer_8849*>\r\n| 7 Engagement in goal setting\r\n| <*A
nswer_8850*>\r\n| 8 Adherence to plan of care\r\n| <*Answer_8851*>\r\n| 9 Coping Skills\r\n| <*Answer_8852*>\r\n| 10 Mental health symptom severity\r\n| <*Answer_8853*>\r\n| 11 Substance use\r\n| <*Answer_8
854*>\r\n| 12 Living Situation\/Housing\r\n| <*Answer_8855*>\r\n| 13 Employment\/Financial\r\n| <*Answer_8856*>\r\n| 14 Social support\/relationships\r\n| <*Answer_8857*>\r\n| 15 Abuse\/Neglect\/Violence\r\n|
<*Answer_8858*>\r\n| 16 Legal issues\r\n| <*Answer_8859*>\r\n| 17 Functional (Activities of Daily Living (ADLS)\/Instrumental Activities of Daily Living (IADLs)\r\n| <*Answer_8860*>\r\n| 18 Care coordination, compl
5390,"choiceText":"New patient","ien":109069,"legacyValue":1,"sequence":2},{"choiceId":5391,"choiceText":"Negative experience\/dissatisfaction\/distrust","ien":109070,"legacyValue":2,"sequence":3},{"choiceId":5392,"choiceText":"Repeated neg
exity and integration\r\n| <*Answer_8861*>\r\n| 19 Disease and symptom severity\r\n| <*Answer_8862*>\r\n| 20 Comorbid medical diagnoses and\/or injuries\r\n| <*Answer_8863*>\r\n| \r\n|Information contained in this n
ote is based on a self-report assessment \r\n|and is not sufficient to use alone for diagnostic purposes. Assessment \r\n|results should be verified for accuracy and used in conjunction with \r\n|other diagnostic activities."},"scaleGroup":
[{"grid1":0,"grid2":0,"grid3":0,"id":349,"instrument":299,"name":"CCICM20","ordInc":1,"ordMax":97,"ordMin":0,"ordTitle":"CCICM20","scale":[{"groupId":349,"id":1461,"name":"CCICM20 TOTAL","scoringKey":[{"id":14511,"questionId":8844,"scaleId"
:1461,"targetText":"No difficulites","value":0},{"id":14512,"questionId":8844,"scaleId":1461,"targetText":"Mild difficulties (1-2 examples)","value":1},{"id":14513,"questionId":8844,"scaleId":1461,"targetText":"Moderate difficulties (3-4 ex
amples)","value":2},{"id":14514,"questionId":8844,"scaleId":1461,"targetText":"Severe difficulties (1 significant cognitive disorder\/decline or 5+ examples)","value":3},{"id":14515,"questionId":8845,"scaleId":1461,"targetText":"Adequate a
ccess to healthcare","value":0},{"id":14516,"questionId":8845,"scaleId":1461,"targetText":"Mild limitations\/difficulties (1-2 barriers)","value":1},{"id":14517,"questionId":8845,"scaleId":1461,"targetText":"Moderate limitations\/difficulti
es (3-4 barriers)","value":2},{"id":14518,"questionId":8845,"scaleId":1461,"targetText":"Severe barriers to adequate access to care (5+ barriers)","value":3},{"id":14519,"questionId":8846,"scaleId":1461,"targetText":"No problems and satisfi
ed with treatment and healthcare team","value":0},{"id":14520,"questionId":8846,"scaleId":1461,"targetText":"New patient","value":1},{"id":14521,"questionId":8846,"scaleId":1461,"targetText":"Negative experience\/dissatisfaction\/distrust",
"value":2},{"id":14522,"questionId":8846,"scaleId":1461,"targetText":"Repeated negative experiences","value":3},{"id":14523,"questionId":8847,"scaleId":1461,"targetText":"No admissions or ED visits in the past 12 months","value":0},{"id":14
524,"questionId":8847,"scaleId":1461,"targetText":"One to two admissions or ED visits in the past 12 months","value":1},{"id":14525,"questionId":8847,"scaleId":
ative experiences","ien":109071,"legacyValue":3,"sequence":4}],"choiceDisplay":81370,"choiceIdentifier":"N","choiceIdentifierIen":42316,"choiceTypeId":15071,"designator":3,"hint":null,"id":8911,"instrument":299,"introDisplay":82614,"introId
1461,"targetText":"Three or four admissions or ED visits in the past 12 months","value":2},{"id":14526,"questionId":8847,"scaleId":1461,"targetText":"Five or more admissions or four ED visits in the past 12 months","value":3},{"id":14527,"q
uestionId":8848,"scaleId":1461,"targetText":"Consistent engagement in shared decision-making in care planning and treatment interventions","value":0},{"id":14528,"questionId":8848,"scaleId":1461,"targetText":"Frequent engagement in shared d
ecision-making in care planning and treatment interventions","value":1},{"id":14529,"questionId":8848,"scaleId":1461,"targetText":"Occasional engagement in shared decision-making in care planning and treatment interventions","value":2},{"id
":14530,"questionId":8848,"scaleId":1461,"targetText":"Minimal or no engagement in shared decision-making in care planning and treatment interventions","value":3},{"id":14531,"questionId":8849,"scaleId":1461,"targetText":"Action\/Maintenanc
e stages with minimal support needed","value":0},{"id":14532,"questionId":8849,"scaleId":1461,"targetText":"Preparation for change with readiness to connect to resources","value":1},{"id":14533,"questionId":8849,"scaleId":1461,"targetText":
"Contemplation requiring redirection and reinforcement","value":2},{"id":14534,"questionId":8849,"scaleId":1461,"targetText":"Pre-contemplation and not ready for change","value":3},{"id":14535,"questionId":8850,"scaleId":1461,"targetText":"
Goals are identified, and actively engaged in all steps to achieve goals","value":0},{"id":14536,"questionId":8850,"scaleId":1461,"targetText":"Goals are identified, but partially engaged in achieving goals","value":1},{"id":14537,"question
Id":8850,"scaleId":1461,"targetText":"Goals are identified, but no engagement in achieving goals","value":2},{"id":14538,"questionId":8850,"scaleId":1461,"targetText":"No goals are identified; No motivation to set goals","value":3},{"id":14
539,"questionId":8851,"scaleId":1461,"targetText":"Adherence with plan of care","value":0},{"id":14540,"questionId":8851,"scaleId":1461,"targetText":"Adherence with plan of care with periodic reinforcement needed, (for example, sporadic unt
imely medication refills or doses, less than 5 no-shows or cancellations by Veteran in 12 months)","value":1},{"id":14541,"questionId":8851,"scaleId":1461,"targetText":"Inconsistent and sporadic adherences with plan of care, (for example, f
":2478,"introText":"SELF-MANAGEMENT|\r\n\r\nWhen choosing a score and multiple selections apply, select highest score.\r\n\r\n","max":0,"min":0,"questionDisplay":97350,"questionId":8846,"questionText":"Experience with providers and healthca
requent untimely medication refills or doses, 5 to 10 no-shows or cancellations in the past 12 months)","value":2},{"id":14542,"questionId":8851,"scaleId":1461,"targetText":"Non-adherence with plan of care and at high risk for decline, (for
example, repeated need for urgent\/emergent services, not taking medications, more than 10 no-shows in the past 12 months)","value":3},{"id":14543,"questionId":8852,"scaleId":1461,"targetText":"Adequate coping skills: Generally able to man
age life stressors and health challenges","value":0},{"id":14544,"questionId":8852,"scaleId":1461,"targetText":"Mild difficulty with coping: Episodic\/situational with potential difficulty for quick resolution","value":2},{"id":14545,"quest
ionId":8852,"scaleId":1461,"targetText":"Moderate difficulty with coping: Utilizing multiple resources without the need for inpatient treatment","value":5},{"id":14546,"questionId":8852,"scaleId":1461,"targetText":"Severe difficulty: Active
crisis state with inpatient treatment needed","value":8},{"id":14547,"questionId":8853,"scaleId":1461,"targetText":"No Mental Health history","value":0},{"id":14548,"questionId":8853,"scaleId":1461,"targetText":"History of MH with no curre
nt concerns\/symptoms; Active MH symptoms being adequately addressing in MH treatment","value":2},{"id":14549,"questionId":8853,"scaleId":1461,"targetText":"Active MH concerns with disruption to daily functioning","value":5},{"id":14550,"qu
estionId":8853,"scaleId":1461,"targetText":
"Inpatient psychiatric admissions and persistent or severe disruption to daily functioning, for example, SI\/HI, psychotic symptoms","value":8},{"id":14551,"questionId":8854,"scaleId":1461,"targetText":"No Substance use disorder history","v
alue":0},{"id":14552,"questionId":8854,"scaleId":1461,"targetText":"History of substance use disorder but now in remission; No current concerns","value":2},{"id":14553,"questionId":8854,"scaleId":1461,"targetText":"Active substance use with
mild disruption to daily functioning (for example, work, school, home)","value":5},{"id":14554,"questionId":8854,"scaleId":1461,"targetText":"Active substance use with severe disruption to daily functioning (for example, inpatient admissio
re team","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":30},{"choice":[{"choiceId":5393,"choiceText":"No admissions or ED visits in the past 12 months","ien":109072,"legacyValue":0,"sequence":
n, suicide\/behavioral\/substance seeking flag).","value":8},{"id":14555,"questionId":8855,"scaleId":1461,"targetText":"Stable housing; No concerns","value":0},{"id":14556,"questionId":8855,"scaleId":1461,"targetText":"Stable housing but de
pendent on support of others","value":1},{"id":14557,"questionId":8855,"scaleId":1461,"targetText":"Unstable housing or not suitable to needs (for example, utility disruption, non-ADA accessible, pest infestation, unaffordable, hoarding, un
safe living conditions)","value":3},{"id":14558,"questionId":8855,"scaleId":1461,"targetText":"No housing\/homeless","value":5},{"id":14559,"questionId":8856,"scaleId":1461,"targetText":"No employment\/financial concerns","value":0},{"id":1
4560,"questionId":8856,"scaleId":1461,"targetText":"Employment concerns\/mild financial strain","value":1},{"id":14561,"questionId":8856,"scaleId":1461,"targetText":"Employment concerns\/moderate financial strain","value":3},{"id":14562,"qu
estionId":8856,"scaleId":1461,"targetText":"Employment concerns\/severe financial strain","value":5},{"id":14563,"questionId":8857,"scaleId":1461,"targetText":"Generally stable social relationships or engagement with leisure activities","va
lue":0},{"id":14564,"questionId":8857,"scaleId":1461,"targetText":"Limited social relationships or moderate engagement with leisure activities","value":1},{"id":14565,"questionId":8857,"scaleId":1461,"targetText":"Limited social relationshi
ps or mild engagement with leisure activities","value":3},{"id":14566,"questionId":8857,"scaleId":1461,"targetText":"Socially isolated or no engagement with leisure activities","value":5},{"id":14567,"questionId":8858,"scaleId":1461,"target
Text":"No abuse\/neglect\/violence suspected, reported or confirmed","value":0},{"id":14568,"questionId":8858,"scaleId":1461,"targetText":"History of abuse\/neglect\/violence","value":1},{"id":14569,"questionId":8858,"scaleId":1461,"targetT
ext":"Suspected active abuse\/neglect\/violence","value":3},{"id":14570,"questionId":8858,"scaleId":1461,"targetText":"Confirmed active abuse\/neglect\/violence","value":5},{"id":14571,"questionId":8859,"scaleId":1461,"targetText":"No activ
e or past legal issues known or recorded","value":0},{"id":14572,"questionId":8859,"scaleId":1461,"targetText":"Past or current legal issues with minimal impact on quality of life","value":1},{"id":14573,"questionId":8859,"scaleId":1461,"ta
1},{"choiceId":5394,"choiceText":"One to two admissions or ED visits in the past 12 months","ien":109073,"legacyValue":1,"sequence":2},{"choiceId":5395,"choiceText":"Three or four admissions or ED visits in the past 12 months","ien":109074,
rgetText":"Past legal issues with major impact on quality of life (for example, felony, multiple charges)","value":3},{"id":14574,"questionId":8859,"scaleId":1461,"targetText":"Current\/Pending legal issues with major impact on quality of l
ife (for example, felony, multiple charges)","value":5},{"id":14575,"questionId":8860,"scaleId":1461,"targetText":"Independent for ADLs {walking, bathing} and IADLs {cooking, driving, shopping}","value":0},{"id":14576,"questionId":8860,"sca
leId":1461,"targetText":"Independent for ADLs but not IADLs","value":2},{"id":14577,"questionId":8860,"scaleId":1461,"targetText":"Requires assistive support for both ADLs and IADLS (1-2 ADLs)","value":4},{"id":14578,"questionId":8860,"scal
eId":1461,"targetText":"Requires significant support for ADLs and IADLS (3+ ADLs)","value":6},{"id":14579,"questionId":8861,"scaleId":1461,"targetText":
"Care is coordinated, integrated and no concerns in communication","value":0},{"id":14580,"questionId":8861,"scaleId":1461,"targetText":"Has Primary Care Provider with limited communication\/coordination\/integration","value":2},{"id":14581
,"questionId":8861,"scaleId":1461,"targetText":"Has PCP and other providers without evidence of communication\/coordination\/integration","value":4},{"id":14582,"questionId":8861,"scaleId":1461,"targetText":"Unassigned and\/or frequent prov
ider changes without evidence of communication\/coordination\/integration","value":6},{"id":14583,"questionId":8862,"scaleId":1461,"targetText":"No symptom concerns","value":0},{"id":14584,"questionId":8862,"scaleId":1461,"targetText":"Well
-managed by Patient Aligned Care Team; may experience mild signs or symptoms with no interference in well-being or daily life","value":2},{"id":14585,"questionId":8862,"scaleId":1461,"targetText":"Requires specialty referrals for management
; moderate signs or symptoms with major interference in well-being or daily life","value":4},{"id":14586,"questionId":8862,"scaleId":1461,"targetText":"Requires specialty referrals for management; severe signs or symptoms with risk of perma
nent deficit or death","value":6},{"id":14587,"questionId":8863,"scaleId":1461,"targetText":"No chronic disease diagnosis and\/or injury","value":0},{"id":14588,"questionId":8863,"scaleId":1461,"targetText":"At least one chronic disease and
"legacyValue":2,"sequence":3},{"choiceId":5396,"choiceText":"Five or more admissions or four ED visits in the past 12 months","ien":109075,"legacyValue":3,"sequence":4}],"choiceDisplay":81370,"choiceIdentifier":"N","choiceIdentifierIen":423
\/or serious persistent injury","value":2},{"id":14589,"questionId":8863,"scaleId":1461,"targetText":"Has 2-3 chronic diseases and\/or serious persistent injuries","value":4},{"id":14590,"questionId":8863,"scaleId":1461,"targetText":"Has 4+
chronic diseases and\/or serious persistent injuries","value":6}],"sequence":10,"xLabel":"TOTAL"},{"groupId":349,"id":1462,"name":"CCICM20 SELF-MGMT","scoringKey":[{"id":14591,"questionId":8844,"scaleId":1462,"targetText":"No difficulites"
,"value":0},{"id":14592,"questionId":8844,"scaleId":1462,"targetText":"Mild difficulties (1-2 examples)","value":1},{"id":14593,"questionId":8844,"scaleId":1462,"targetText":"Moderate difficulties (3-4 examples)","value":2},{"id":14594,"que
stionId":8844,"scaleId":1462,"targetText":"Severe difficulties (1 significant cognitive disorder\/decline or 5+ examples)","value":3},{"id":14595,"questionId":8845,"scaleId":1462,"targetText":"Adequate access to healthcare","value":0},{"id
":14596,"questionId":8845,"scaleId":1462,"targetText":"Mild limitations\/difficulties (1-2 barriers)","value":1},{"id":14597,"questionId":8845,"scaleId":1462,"targetText":"Moderate limitations\/difficulties (3-4 barriers)","value":2},{"id":
14598,"questionId":8845,"scaleId":1462,"targetText":"Severe barriers to adequate access to care (5+ barriers)","value":3},{"id":14599,"questionId":8846,"scaleId":1462,"targetText":"No problems and satisfied with treatment and healthcare tea
m","value":0},{"id":14600,"questionId":8846,"scaleId":1462,"targetText":"New patient","value":1},{"id":14601,"questionId":8846,"scaleId":1462,"targetText":"Negative experience\/dissatisfaction\/distrust","value":2},{"id":14602,"questionId":
8846,"scaleId":1462,"targetText":"Repeated negative experiences","value":3},{"id":14603,"questionId":8847,"scaleId":1462,"targetText":"No admissions or ED visits in the past 12 months","value":0},{"id":14604,"questionId":8847,"scaleId":1462
,"targetText":"One to two admissions or ED visits in the past 12 months","value":1},{"id":14605,"questionId":8847,"scaleId":1462,"targetText":"Three or four admissions or ED visits in the past 12 months","value":2},{"id":14606,"questionId":
8847,"scaleId":1462,"targetText":"Five or more admissions or four ED visits in the past 12 months","value":3},{"id":14607,"questionId":8848,"scaleId":1462,"targetText":"Consistent engagement in shared decision-making in care planning and tr
17,"choiceTypeId":15072,"designator":4,"hint":null,"id":8912,"instrument":299,"introDisplay":82614,"introId":2478,"introText":"SELF-MANAGEMENT|\r\n
eatment interventions","value":0},{"id":14608,"questionId":8848,"scaleId":1462,"targetText":
"Frequent engagement in shared decision-making in care planning and treatment interventions","value":1},{"id":14609,"questionId":8848,"scaleId":1462,"targetText":"Occasional engagement in shared decision-making in care planning and treatmen
t interventions","value":2},{"id":14610,"questionId":8848,"scaleId":1462,"targetText":"Minimal or no engagement in shared decision-making in care planning and treatment interventions","value":3},{"id":14611,"questionId":8849,"scaleId":1462,
"targetText":"Action\/Maintenance stages with minimal support needed","value":0},{"id":14612,"questionId":8849,"scaleId":1462,"targetText":"Preparation for change with readiness to connect to resources","value":1},{"id":14613,"questionId":8
849,"scaleId":1462,"targetText":"Contemplation requiring redirection and reinforcement","value":2},{"id":14614,"questionId":8849,"scaleId":1462,"targetText":"Pre-contemplation and not ready for change","value":3},{"id":14615,"questionId":88
50,"scaleId":1462,"targetText":"Goals are identified, and actively engaged in all steps to achieve goals","value":0},{"id":14616,"questionId":8850,"scaleId":1462,"targetText":"Goals are identified, but partially engaged in achieving goals",
"value":1},{"id":14617,"questionId":8850,"scaleId":1462,"targetText":"Goals are identified, but no engagement in achieving goals","value":2},{"id":14618,"questionId":8850,"scaleId":1462,"targetText":"No goals are identified; No motivation t
o set goals","value":3},{"id":14619,"questionId":8851,"scaleId":1462,"targetText":"Adherence with plan of care","value":0},{"id":14620,"questionId":8851,"scaleId":1462,"targetText":"Adherence with plan of care with periodic reinforcement ne
eded, (for example, sporadic untimely medication refills or doses, less than 5 no-shows or cancellations by Veteran in 12 months)","value":1},{"id":14621,"questionId":8851,"scaleId":1462,"targetText":"Inconsistent and sporadic adherences wi
th plan of care, (for example, frequent untimely medication refills or doses, 5 to 10 no-shows or cancellations in the past 12 months)","value":2},{"id":14622,"questionId":8851,"scaleId":1462,"targetText":"Non-adherence with plan of care an
\r\nWhen choosing a score and multiple selections apply, select highest score.\r\n\r\n","max":0,"min":0,"questionDisplay":97350,"questionId":8847,"questionText":"Utilization","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","
d at high risk for decline, (for example, repeated need for urgent\/emergent services, not taking medications, more than 10 no-shows in the past 12 months)","value":3}],"sequence":20,"xLabel":"TOTAL"},{"groupId":349,"id":1463,"name":"CCICM2
0 MH\/BH","scoringKey":[{"id":14623,"questionId":8852,"scaleId":1463,"targetText":"Adequate coping skills: Generally able to manage life stressors and health challenges","value":0},{"id":14624,"questionId":8852,"scaleId":1463,"targetText":"
Mild difficulty with coping: Episodic\/situational with potential difficulty for quick resolution","value":2},{"id":14625,"questionId":8852,"scaleId":1463,"targetText":"Moderate difficulty with coping: Utilizing multiple resources without t
he need for inpatient treatment","value":5},{"id":14626,"questionId":8852,"scaleId":1463,"targetText":"Severe difficulty: Active crisis state with inpatient treatment needed","value":8},{"id":14627,"questionId":8853,"scaleId":1463,"targetTe
xt":"No Mental Health history","value":0},{"id":14628,"questionId":8853,"scaleId":1463,"targetText":"History of MH with no current concerns\/symptoms; Active MH symptoms being adequately addressing in MH treatment","value":2},{"id":14629,"q
uestionId":8853,"scaleId":1463,"targetText":"Active MH concerns with disruption to daily functioning","value":5},{"id":14630,"questionId":8853,"scaleId":1463,"targetText":"Inpatient psychiatric admissions and persistent or severe disruption
to daily functioning, for example, SI\/HI, psychotic symptoms","value":8},{"id":14631,"questionId":8854,"scaleId":1463,"targetText":"No Substance use disorder history","value":0},{"id":14632,"questionId":8854,"scaleId":1463,"targetText":"H
istory of substance use disorder but now in remission; No current concerns","value":2},{"id":14633,"questionId":8854,"scaleId":1463,"targetText":
"Active substance use with mild disruption to daily functioning (for example, work, school, home)","value":5},{"id":14634,"questionId":8854,"scaleId":1463,"targetText":"Active substance use with severe disruption to daily functioning (for e
xample, inpatient admission, suicide\/behavioral\/substance seeking flag).","value":8}],"sequence":30,"xLabel":"TOTAL"},{"groupId":349,"id":1464,"name":"CCICM20 SOCIAL","scoringKey":[{"id":14635,"questionId":8855,"scaleId":1464,"targetText"
restrictFrom":null,"sequence":40},{"choice":[{"choiceId":5397,"choiceText":"Consistent engagement in shared decision-making in care planning and treatment interventions","ien":109076,"legacyValue":0,"sequence":1},{"choiceId":5398,"choiceTex
:"Stable housing; No concerns","value":0},{"id":14636,"questionId":8855,"scaleId":1464,"targetText":"Stable housing but dependent on support of others","value":1},{"id":14637,"questionId":8855,"scaleId":1464,"targetText":"Unstable housing o
r not suitable to needs (for example, utility disruption, non-ADA accessible, pest infestation, unaffordable, hoarding, unsafe living conditions)","value":3},{"id":14638,"questionId":8855,"scaleId":1464,"targetText":"No housing\/homeless","
value":5},{"id":14639,"questionId":8856,"scaleId":1464,"targetText":"No employment\/financial concerns","value":0},{"id":14640,"questionId":8856,"scaleId":1464,"targetText":"Employment concerns\/mild financial strain","value":1},{"id":14641
,"questionId":8856,"scaleId":1464,"targetText":"Employment concerns\/moderate financial strain","value":3},{"id":14642,"questionId":8856,"scaleId":1464,"targetText":"Employment concerns\/severe financial strain","value":5},{"id":14643,"ques
tionId":8857,"scaleId":1464,"targetText":"Generally stable social relationships or engagement with leisure activities","value":0},{"id":14644,"questionId":8857,"scaleId":1464,"targetText":"Limited social relationships or moderate engagement
with leisure activities","value":1},{"id":14645,"questionId":8857,"scaleId":1464,"targetText":"Limited social relationships or mild engagement with leisure activities","value":3},{"id":14646,"questionId":8857,"scaleId":1464,"targetText":"S
ocially isolated or no engagement with leisure activities","value":5},{"id":14647,"questionId":8858,"scaleId":1464,"targetText":"No abuse\/neglect\/violence suspected, reported or confirmed","value":0},{"id":14648,"questionId":8858,"scaleId
":1464,"targetText":"History of abuse\/neglect\/violence","value":1},{"id":14649,"questionId":8858,"scaleId":1464,"targetText":"Suspected active abuse\/neglect\/violence","value":3},{"id":14650,"questionId":8858,"scaleId":1464,"targetText":
"Confirmed active abuse\/neglect\/violence","value":5},{"id":14651,"questionId":8859,"scaleId":1464,"targetText":"No active or past legal issues known or recorded","value":0},{"id":14652,"questionId":8859,"scaleId":1464,"targetText":"Past o
r current legal issues with minimal impact on quality of life","value":1},{"id":14653,"questionId":8859,"scaleId":1464,"targetText":"Past legal issues with major impact on quality of life (for example, felony, multiple charges)","value":3},
d":5383,"choiceText":"Moderate difficulties (3-4 examples)","ien":109062,"legacyValue":2,"sequence":3},{"choiceId":5384,"choiceText":"Severe difficulties (1 significant cognitive disorder\/decline or 5+ examples)","ien":109063,"legacyValue
t":"Frequent engagement in shared decision-making in care planning and treatment interventions","ien":109077,"legacyValue":1,"sequence":2},{"choiceId":5399,"choiceText":"Occasional engagement in shared decision-making in care planning and t
{"id":14654,"questionId":8859,"scaleId":1464,"targetText":"Current\/Pending legal issues with major impact on quality of life (for example, felony, multiple charges)","value":5}],"sequence":40,"xLabel":"TOTAL"},{"groupId":349,"id":1465,"nam
e":"CCICM20 MED\/PHYS","scoringKey":[{"id":14655,"questionId":8860,"scaleId":1465,"targetText":"Independent for ADLs {walking, bathing} and IADLs {cooking, driving, shopping}","value":0},{"id":14656,"questionId":8860,"scaleId":1465,"targetT
ext":"Independent for ADLs but not IADLs","value":2},{"id":14657,"questionId":8860,"scaleId":1465,"targetText":"Requires assistive support for both ADLs and IADLS (1-2 ADLs)","value":4},{"id":14658,"questionId":8860,"scaleId":1465,"targetTe
xt":"Requires significant support for ADLs and IADLS (3+ ADLs)","value":6},{"id":14659,"questionId":8861,"scaleId":1465,"targetText":"Care is coordinated, integrated and no concerns in communication","value":0},{"id":14660,"questionId":8861
,"scaleId":1465,"targetText":"Has Primary Care Provider with limited communication\/coordination\/integration","value":2},{"id":14661,"questionId":8861,"scaleId":
1465,"targetText":"Has PCP and other providers without evidence of communication\/coordination\/integration","value":4},{"id":14662,"questionId":8861,"scaleId":1465,"targetText":"Unassigned and\/or frequent provider changes without evidence
of communication\/coordination\/integration","value":6},{"id":14663,"questionId":8862,"scaleId":1465,"targetText":"No symptom concerns","value":0},{"id":14664,"questionId":8862,"scaleId":1465,"targetText":"Well-managed by Patient Aligned C
are Team; may experience mild signs or symptoms with no interference in well-being or daily life","value":2},{"id":14665,"questionId":8862,"scaleId":1465,"targetText":"Requires specialty referrals for management; moderate signs or symptoms
with major interference in well-being or daily life","value":4},{"id":14666,"questionId":8862,"scaleId":1465,"targetText":"Requires specialty referrals for management; severe signs or symptoms with risk of permanent deficit or death","value
":6},{"id":14667,"questionId":8863,"scaleId":1465,"targetText":"No chronic disease diagnosis and\/or injury","value":0},{"id":14668,"questionId":8863,"scaleId":1465,"targetText":"At least one chronic disease and\/or serious persistent injur
reatment interventions","ien":109078,"legacyValue":2,"sequence":3},{"choiceId":5400,"choiceText":"Minimal or no engagement in shared decision-making in care planning and treatment interventions","ien":109079,"legacyValue":3,"sequence":4}],"
y","value":2},{"id":14669,"questionId":8863,"scaleId":1465,"targetText":"Has 2-3 chronic diseases and\/or serious persistent injuries","value":4},{"id":14670,"questionId":8863,"scaleId":1465,"targetText":"Has 4+ chronic diseases and\/or ser
ious persistent injuries","value":6}],"sequence":50,"xLabel":"TOTAL"}],"sequence":10}],"spec":{"entryChecksum":387852216,"entrySpec":"{\"name\": \"CCICM20\", \r\n \"restartDays\": 7, \r\n \"printTitle\": \"Care Coordination & Integrated Cas
e Management (CC&ICM) Complexity Assessment\", \r\n \"content\":[\r\n {\"id\": \"i2478\", \"type\": \"IntroText\", \r\n \"text\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n highest score. \
"\r\n }, \r\n {\"id\": \"q8844\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"1. Ability to communicate and understand healthcare needs to obtain services\r\n (e.g. providers, teams, medicat
ion and equipment)\", \r\n \"intro\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n highest score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5381\", \"text\": \" No d
ifficulites\"}, \r\n {\"id\": \"c5382\", \"text\": \" Mild difficulties (1-2 examples)\"}, \r\n {\"id\": \"c5383\", \"text\": \" Moderate difficulties (3-4 examples)\"}, \r\n {\"id\": \"c5384\", \"text\": \" Severe difficulties
(1 significant cognitive disorder\/decline or 5+ examples)\"}\r\n ]}, \r\n {\"id\": \"q8845\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"2. Access to healthcare within VA and\/or Community
Care (e.g. geographical\r\n barriers, transportation, clinic availability and technology availability for\r\n virtual care)\", \r\n \"intro\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n high
est score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5385\", \"text\": \" Adequate access to healthcare\"}, \r\n {\"id\": \"c5386\", \"text\": \" Mild limitations\/difficulties (1-2 barriers)\"}, \r\n {\"
id\": \"c5387\", \"text\": \" Moderate limitations\/difficulties (3-4 barriers)\"}, \r\n {\"id\": \"c5388\", \"text\": \" Severe barriers to adequate access to care (5+ barriers)\"}\r\n ]}, \r\n {\"id\": \"q8846\", \"type\": \"Choic
choiceDisplay":81370,"choiceIdentifier":"N","choiceIdentifierIen":42318,"choiceTypeId":15073,"designator":5,"hint":null,"id":8913,"instrument":299,"introDisplay":82614,"introId":2478,"introText":"SELF-MANAGEMENT|\r\n\r\nWhen choosing a scor
eQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"3. Experience with providers and healthcare team\", \r\n \"intro\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n highest
score. \", \r\n \"columns\": 1, \r\n \"choices\":[
\r\n {\"id\": \"c5389\", \"text\": \" No problems and satisfied with treatment and healthcare team\"}, \r\n {\"id\": \"c5390\", \"text\": \" New patient\"}, \r\n {\"id\": \"c5391\", \"text\": \" Negative experience\/dissatisfact
ion\/distrust\"}, \r\n {\"id\": \"c5392\", \"text\": \" Repeated negative experiences\"}\r\n ]}, \r\n {\"id\": \"q8847\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"4. Utilization\", \r\
n \"intro\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n highest score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5393\", \"text\": \" No admissions or ED visits in
the past 12 months\"}, \r\n {\"id\": \"c5394\", \"text\": \" One to two admissions or ED visits in the past 12 months\"}, \r\n {\"id\": \"c5395\", \"text\": \" Three or four admissions or ED visits in the past 12 months\"}, \r\n
{\"id\": \"c5396\", \"text\": \" Five or more admissions or four ED visits in the past 12 months\"}\r\n ]}, \r\n {\"id\": \"q8848\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"5. Shared De
cision-Making\", \r\n \"intro\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n highest score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5397\", \"text\": \" Consisten
t engagement in shared decision-making in care planning and treatment\r\n interventions\"}, \r\n {\"id\": \"c5398\", \"text\": \" Frequent engagement in shared decision-making in care planning and treatment\r\n interventions\"}, \r\n
{\"id\": \"c5399\", \"text\": \" Occasional engagement in shared decision-making in care planning and treatment\r\n interventions\"}, \r\n {\"id\": \"c5400\", \"text\": \" Minimal or no engagement in shared decision-making in care pla
e and multiple selections apply, select highest score.\r\n\r\n","max":0,"min":0,"questionDisplay":97350,"questionId":8848,"questionText":"Shared Decision-Making","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom"
nning and\r\n treatment interventions\"}\r\n ]}, \r\n {\"id\": \"q8849\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"6. Readiness to change\", \r\n \"intro\": \"SELF-MANAGEMENT<br \/> Whe
n choosing a score and multiple selections apply, select\r\n highest score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5401\", \"text\": \" Action\/Maintenance stages with minimal support needed\"}, \r\n {\"id
\": \"c5402\", \"text\": \" Preparation for change with readiness to connect to resources\"}, \r\n {\"id\": \"c5403\", \"text\": \" Contemplation requiring redirection and reinforcement\"}, \r\n {\"id\": \"c5404\", \"text\": \" Pre-
contemplation and not ready for change\"}\r\n ]}, \r\n {\"id\": \"q8850\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Engagement in goal setting\", \r\n \"intro\": \"SELF-MANAGEMENT<br
\/> When choosing a score and multiple selections apply, select\r\n highest score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5405\", \"text\": \" Goals are identified, and actively engaged in all steps to achiev
e goals\"}, \r\n {\"id\": \"c5406\", \"text\": \" Goals are identified, but partially engaged in achieving goals\"}, \r\n {\"id\": \"c5407\", \"text\": \" Goals are identified, but no engagement in achieving goals\"}, \r\n {\"id
\": \"c5408\", \"text\": \" No goals are identified; No motivation to set goals\"}\r\n ]}, \r\n {\"id\": \"q8851\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"8. Adherence to plan of care\",
\r\n \"intro\": \"SELF-MANAGEMENT<br \/> When choosing a score and multiple selections apply, select\r\n highest score. \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5409\", \"text\": \" Adherence with plan of ca
re\"}, \r\n {\"id\": \"c5410\", \"text\": \" Adherence with plan of care with periodic reinforcement needed, (for example,
\r\n sporadic untimely medication refills or doses, less than 5 no-shows or\r\n cancellations by Veteran in 12 months)\"}, \r\n {\"id\": \"c5411\", \"text\": \" Inconsistent and sporadic adherences with plan of care, (for example, frequ
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ent\r\n untimely medication refills or doses, 5 to 10 no-shows or cancellations in the\r\n past 12 months)\"}, \r\n {\"id\": \"c5412\", \"text\": \" Non-adherence with plan of care and at high risk for decline, (for example,\r\n repeate
d need for urgent\/emergent services, not taking medications, more than 10\r\n no-shows in the past 12 months)\"}\r\n ]}, \r\n {\"id\": \"i2479\", \"type\": \"IntroText\", \r\n \"text\": \"MENTAL HEALTH\/BEHAVIORAL HEALTH<br \/> When
choosing a score and multiple\r\n selections apply, select highest score.\"\r\n }, \r\n {\"id\": \"q8852\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"9. Coping Skills\", \r\n \"intro\"
: \"MENTAL HEALTH\/BEHAVIORAL HEALTH<br \/> When choosing a score and multiple\r\n selections apply, select highest score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5413\", \"text\": \" Adequate coping skills: Gen
erally able to manage life stressors and health\r\n challenges\"}, \r\n {\"id\": \"c5414\", \"text\": \" Mild difficulty with coping: Episodic\/situational with potential difficulty for\r\n quick resolution\"}, \r\n {\"id\": \"c5415
\", \"text\": \" Moderate difficulty with coping: Utilizing multiple resources without the need\r\n for inpatient treatment\"}, \r\n {\"id\": \"c5416\", \"text\": \" Severe difficulty: Active crisis state with inpatient treatment needed
\"}\r\n ]}, \r\n {\"id\": \"q8853\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"10. Mental health symptom severity\", \r\n \"intro\": \"MENTAL HEALTH\/BEHAVIORAL HEALTH<br \/> When choosi
ng a score and multiple\r\n selections apply, select highest score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5417\", \"text\": \" No Mental Health history\"}, \r\n {\"id\": \"c5418\", \"text\": \" History of
MH with no current concerns\/symptoms; Active MH symptoms being\r\n adequately addressing in MH treatment\"}, \r\n {\"id\": \"c5419\", \"text\": \" Active MH concerns with disruption to daily functioning\"}, \r\n {\"id\": \"c5420\",
\"text\": \" Inpatient psychiatric admissions and persistent or severe disruption to daily\r\n functioning, for example, SI\/HI, psychotic symptoms\"}\r\n ]}, \r\n {\"id\": \"q8854\", \"type\": \"ChoiceQuestion\", \"required\": true, \
t to resources","ien":109081,"legacyValue":1,"sequence":2},{"choiceId":5403,"choiceText":"Contemplation requiring redirection and reinforcement","ien":109082,"legacyValue":2,"sequence":3},{"choiceId":5404,"choiceText":"Pre-contemplation and
"inline\": false, \r\n \"text\": \"11. Substance use\", \r\n \"intro\": \"MENTAL HEALTH\/BEHAVIORAL HEALTH<br \/> When choosing a score and multiple\r\n selections apply, select highest score.\", \r\n \"columns\": 1, \r\n \"choi
ces\":[\r\n {\"id\": \"c5421\", \"text\": \" No Substance use disorder history\"}, \r\n {\"id\": \"c5422\", \"text\": \" History of substance use disorder but now in remission; No current concerns\"}, \r\n {\"id\": \"c5423\", \"
text\": \" Active substance use with mild disruption to daily functioning (for example,\r\n work, school, home)\"}, \r\n {\"id\": \"c5424\", \"text\": \" Active substance use with severe disruption to daily functioning (for example,\r\n
inpatient admission, suicide\/behavioral\/substance seeking flag).\"}\r\n ]}, \r\n {\"id\": \"i2480\", \"type\": \"IntroText\", \r\n \"text\": \"SOCIAL<br \/> When choosing a score and multiple selections apply, select highest\r\n s
core.\"\r\n }, \r\n {\"id\": \"q8855\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"12. Living Situation\/Housing\", \r\n \"intro\": \"SOCIAL<br \/> When choosing a score and multiple sel
ections apply, select highest\r\n score.\", \r\n \"columns\": 1, \r\n \"choices\":[
\r\n {\"id\": \"c5425\", \"text\": \" Stable housing; No concerns\"}, \r\n {\"id\": \"c5426\", \"text\": \" Stable housing but dependent on support of others\"}, \r\n {\"id\": \"c5427\", \"text\": \" Unstable housing or not suit
able to needs (for example, utility disruption,\r\n non-ADA accessible, pest infestation, unaffordable, hoarding, unsafe living\r\n conditions)\"}, \r\n {\"id\": \"c5428\", \"text\": \" No housing\/homeless\"}\r\n ]}, \r\n {\"id\":
\"q8856\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"13. Employment\/Financial\", \r\n \"intro\": \"SOCIAL<br \/> When choosing a score and multiple selections apply, select highest\r\n scor
e.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5429\", \"text\": \" No employment\/financial concerns\"}, \r\n {\"id\": \"c5430\", \"text\": \" Employment concerns\/mild financial strain\"}, \r\n {\"id\": \"
not ready for change","ien":109083,"legacyValue":3,"sequence":4}],"choiceDisplay":81370,"choiceIdentifier":"N","choiceIdentifierIen":42319,"choiceTypeId":15074,"designator":6,"hint":null,"id":8914,"instrument":299,"introDisplay":82614,"int
c5431\", \"text\": \" Employment concerns\/moderate financial strain\"}, \r\n {\"id\": \"c5432\", \"text\": \" Employment concerns\/severe financial strain\"}\r\n ]}, \r\n {\"id\": \"q8857\", \"type\": \"ChoiceQuestion\", \"required
\": true, \"inline\": false, \r\n \"text\": \"14. Social support\/relationships\", \r\n \"intro\": \"SOCIAL<br \/> When choosing a score and multiple selections apply, select highest\r\n score.\", \r\n \"columns\": 1, \r\n \"cho
ices\":[\r\n {\"id\": \"c5433\", \"text\": \" Generally stable social relationships or engagement with leisure activities\"}, \r\n {\"id\": \"c5434\", \"text\": \" Limited social relationships or moderate engagement with leisure act
ivities\"}, \r\n {\"id\": \"c5435\", \"text\": \" Limited social relationships or mild engagement with leisure activities\"}, \r\n {\"id\": \"c5436\", \"text\": \" Socially isolated or no engagement with leisure activities\"}\r\n
]}, \r\n {\"id\": \"q8858\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"15. Abuse\/Neglect\/Violence\", \r\n \"intro\": \"SOCIAL<br \/> When choosing a score and multiple selections apply,
select highest\r\n score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5437\", \"text\": \" No abuse\/neglect\/violence suspected, reported or confirmed\"}, \r\n {\"id\": \"c5438\", \"text\": \" History of abuse\
/neglect\/violence\"}, \r\n {\"id\": \"c5439\", \"text\": \" Suspected active abuse\/neglect\/violence\"}, \r\n {\"id\": \"c5440\", \"text\": \" Confirmed active abuse\/neglect\/violence\"}\r\n ]}, \r\n {\"id\": \"q8859\", \"typ
e\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"16. Legal issues\", \r\n \"intro\": \"SOCIAL<br \/> When choosing a score and multiple selections apply, select highest\r\n score.\", \r\n \"columns\"
: 1, \r\n \"choices\":[\r\n {\"id\": \"c5441\", \"text\": \" No active or past legal issues known or recorded\"}, \r\n {\"id\": \"c5442\", \"text\": \" Past or current legal issues with minimal impact on quality of life\"}, \r\n
{\"id\": \"c5443\", \"text\": \" Past legal issues with major impact on quality of life (for example, felony,\r\n multiple charges)\"}, \r\n {\"id\": \"c5444\", \"text\": \" Current\/Pending legal issues with major impact on quality
roId":2478,"introText":"SELF-MANAGEMENT|\r\n\r\nWhen choosing a score and multiple selections apply, select highest score.\r\n\r\n","max":0,"min":0,"questionDisplay":97350,"questionId":8849,"questionText":"Readiness to change","required":tr
of life (for example,\r\n felony, multiple charges)\"}\r\n ]}, \r\n {\"id\": \"i2481\", \"type\": \"IntroText\", \r\n \"text\": \"MEDICAL\/PHYSICAL<br \/> When choosing a score and multiple selections apply,\r\n select highest score
.\"\r\n }, \r\n {\"id\": \"q8860\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"17. Functional (Activities of Daily Living (ADLS)\/Instrumental Activities of\r\n Daily Living (IADLs)\", \r\n
\"intro\": \"MEDICAL\/PHYSICAL<br \/> When choosing a score and multiple selections apply,\r\n select highest score.\", \r\n \"columns\": 1,
\r\n \"choices\":[\r\n {\"id\": \"c5445\", \"text\": \" Independent for ADLs {walking, bathing} and IADLs {cooking, driving, shopping}\"}, \r\n {\"id\": \"c5446\", \"text\": \" Independent for ADLs but not IADLs\"}, \r\n {\"i
d\": \"c5447\", \"text\": \" Requires assistive support for both ADLs and IADLS (1-2 ADLs)\"}, \r\n {\"id\": \"c5448\", \"text\": \" Requires significant support for ADLs and IADLS (3+ ADLs)\"}\r\n ]}, \r\n {\"id\": \"q8861\", \"typ
e\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"18. Care coordination, complexity and integration\", \r\n \"intro\": \"MEDICAL\/PHYSICAL<br \/> When choosing a score and multiple selections apply,\r\n
select highest score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5449\", \"text\": \" Care is coordinated, integrated and no concerns in communication\"}, \r\n {\"id\": \"c5450\", \"text\": \" Has Primary Care
Provider with limited communication\/coordination\/integration\"}, \r\n {\"id\": \"c5451\", \"text\": \" Has PCP and other providers without evidence of\r\n communication\/coordination\/integration\"}, \r\n {\"id\": \"c5452\", \"tex
t\": \" Unassigned and\/or frequent provider changes without evidence of\r\n communication\/coordination\/integration\"}\r\n ]}, \r\n {\"id\": \"q8862\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"tex
t\": \"19. Disease and symptom severity\", \r\n \"intro\": \"MEDICAL\/PHYSICAL<br \/> When choosing a score and multiple selections apply,\r\n select highest score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c545
ue,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":60},{"choice":[{"choiceId":5405,"choiceText":"Goals are identified, and actively engaged in all steps to achieve goals","ien":109084,"legacyValue":0,"sequence
3\", \"text\": \" No symptom concerns\"}, \r\n {\"id\": \"c5454\", \"text\": \" Well-managed by Patient Aligned Care Team; may experience mild signs or symptoms\r\n with no interference in well-being or daily life\"}, \r\n {\"id\":
\"c5455\", \"text\": \" Requires specialty referrals for management; moderate signs or symptoms with\r\n major interference in well-being or daily life\"}, \r\n {\"id\": \"c5456\", \"text\": \" Requires specialty referrals for managemen
t; severe signs or symptoms with risk\r\n of permanent deficit or death\"}\r\n ]}, \r\n {\"id\": \"q8863\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"20. Comorbid medical diagnoses and\/or
injuries\", \r\n \"intro\": \"MEDICAL\/PHYSICAL<br \/> When choosing a score and multiple selections apply,\r\n select highest score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5457\", \"text\": \" No chronic di
sease diagnosis and\/or injury\"}, \r\n {\"id\": \"c5458\", \"text\": \" At least one chronic disease and\/or serious persistent injury\"}, \r\n {\"id\": \"c5459\", \"text\": \" Has 2-3 chronic diseases and\/or serious persistent in
juries\"}, \r\n {\"id\": \"c5460\", \"text\": \" Has 4+ chronic diseases and\/or serious persistent injuries\"}\r\n ]}]\r\n}","instrument":299,"lastUpdate":"2025-10-28T14:51:46","specIen":149},"verify":["601.71:299","601.72:8844","601
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