Development of a National Adult Protective Services Data System: Namrs Pilot Final Report (volume 1). Appendix G. Namrs Pilot Case Component Mapping Form

09/25/2015

G.1. Investigation

Entity: Investigation
Element Name: Investigation ID Element #: Inv1
Type: Alphanumeric Size: 32 Required: Yes Quantifier: Single Last Revised: 12/17/2014
Element Description:
The unique identifier used by the state for each investigation. The identifier is assigned to a specific investigation and is only used once. The Investigation identifier is encrypted or encoded by the state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Investigation
Element Name: Report Date Element #: Inv2
Type: Date Size: 8 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The month, day, and year the agency was notified of the suspected adult maltreatment.
Code Values:
Not applicable.
Other Instructions:
This is the date that a report of suspected maltreatment was made. If an agency combines several reports into one investigation, the Report Date is the date of the earliest report. The determination of combining reports into one investigation is per each agency's policy and procedures.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Investigation
Element Name: Report Source Element #: Inv3
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/11/2014
Element Description:
The role or profession of the person who made the report of the suspected adult maltreatment.
Code Values:
1 = Guardian or Conservator
2 = Community-Based Services
3 = Education
4 = Financial
5 = Law Enforcement, Judicial, or Legal
6 = Medical or Health
7 = Mental Health
8 = Residential Care Community
9 = Social Service and Rehabilitative Services
10 = Other Professional
11 = Self
12 = Family Member
13 = Non-Family Member
14 = Anonymous
Other Instructions:
If an agency combines several reports into one investigation, submit the Report Source of the earliest report.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Investigation
Element Name: Report Source Element #: Inv3
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/11/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Investigation
Element Name: State/County FIPS Code of Investigative Agency Element #: Inv4
Type: Numeric Size: 5 Required: No Quantifier: Single Last Revised: 12/17/2014
Element Description:
The FIPS for state (2 digits) and county code (3 digits) of the APS agency.
Code Values:
Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Other Instructions:
All investigations will have the same state identification number. The Investigative Agency number may be a regional office or a local office depending upon the state APS administrative structure.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Investigation
Element Name: Investigation Start Date Element #: Inv5
Type: Date Size: 8 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The date the investigation is assigned to an investigation worker. If the agency uses another date to indicate the start of an investigation, that date is used.
Code Values:
Not applicable.
Other Instructions:
Each agency's policies and procedures define the date of an investigation. If an agency has both the date the investigation is assigned to an investigation worker and another date that is considered to be the start of the investigation, submit the date assigned to the worker.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Investigation
Element Name: Investigation Disposition Date Element #: Inv6
Type: Date Size: 8 Required: No Quantifier: Single Last Revised: 12/17/2014
Element Description:
The date that the agency completed dispositions on the allegations of maltreatment associated with the investigation.
Code Values:
Not applicable.
Other Instructions:
Each agency's policies and procedures define this date. If maltreatment dispositions are associated with different dates, the Investigation Disposition Date should be the latest of these dates.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Investigation
Element Name: Case Closure Date Element #: Inv7
Type: Date Size: 8 Required: Yes Quantifier: Single Last Revised: 12/17/2014
Element Description:
The date that the agency completed all activities related to the investigation of the case.
Code Values:
Not applicable.
Other Instructions:
Each agency's policies and procedures define the date of case closure. If the state data does not include the case closure date, the investigation disposition date may be used in this element.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

G.2. Client

Entity: Client
Element Name: Client ID Element #: Clt1
Type: Alphanumeric Size: 32 Required: Yes Quantifier: Single Last Revised: 12/17/2014
Element Description:
The unique identifier used by the state for each client. The identifier is assigned to a specific client and is used identify the same client across investigations and reporting periods. The Client identifier is encrypted or encoded by state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
Multiple unique Client IDs can be associated with an investigation. The determination as to whether an investigation includes multiple clients is left to each agency's policies and procedures.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Facility ID Element #: Clt2
Type: Alphanumeric Size: 32 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The unique identifier used by the state for each facility. The identifier is assigned to a specific facility where the client lives. The identifier is used for the same facility across investigations and reporting periods. The Facility Identifier is encrypted or encoded by the state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: State/County FIPS Code of Client Element #: Clt3
Type: Numeric Size: 5 Required: No Quantifier: Single Last Revised: 12/17/2014
Element Description:
The FIPS for state (2 digits) and county code (3 digits) of the client's residence at the start of the investigation.
Code Values:
Code is the unique identification number assigned to each state and county under the FIPS guidelines. See http://www.census.gov/geo/www/fips/fips.html.
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Case Closure Reason Element #: Clt4
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The primary reason why the case was closed.
Code Values:
1 = Investigation Complete
2 = Protective Services Completed
3 = Client Refused Services
4 = Unable to Complete (closed without finding)
5 = Client Died
6 = Other
Other Instructions:
Code 3 is used if the investigation was completed, services were offered, and the client refused services. Code 4 is used if agency was unable to complete the investigation because the client refused the investigation. Code 5 is used if agency was unable to complete the investigation because the client died.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Case Closure Reason Element #: Clt4
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Age Element #: Clt5
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The age of the client in years (at investigation start date).
Code Values:
18,19...74 = Actual Age
75 = 75-84
85 = 85 and Older
Other Instructions:
The Client Age is computed by subtracting the client's Date of Birth from the Investigation Start Date. If the age ranges between 18 and 74, the actual age is used. Ages of 75-84 inclusive are grouped and coded as 75. Ages of 85 or older are grouped and coded as 85.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Gender Identity Element #: Clt6
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The actual or perceived gender-related characteristics of the client.
Code Values:
1 = Male
2 = Female
3 = Transgender
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Gender Identity Element #: Clt6
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Sexual Orientation Element #: Clt7
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The client's enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one's same sex, the other sex, or both sexes.
Code Values:
1 = Straight
2 = Gay/Lesbian
3 = Bisexual
4 = Questioning
5 = Other
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Sexual Orientation Element #: Clt7
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Race Element #: Clt8
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The population(s) or group(s) that the client identifies as being a member. Multiple races can be submitted for the client.
Code Values:
10 = American Indian or Alaska Native
20 = Asian (non-specific)
   21 = Asian Indian
   22 = Chinese
   23 = Filipino
   24 = Japanese
   25 = Korean
   26 = Vietnamese
   27 = Other Asian
30 = Black or African American
40 = Native Hawaiian or Other Pacific Islander (non-specific)
   41 = Native Hawaiian
   42 = Guamanian or Chamorro
   43 = Samoan
   44 = Other Pacific Islander
50 = White
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example if the client is Asian of Filipino and Japanese descent, only submit Code 23 and Code 24. Do not submit Code 20.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Race Element #: Clt8
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Ethnicity Element #: Clt9
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The affiliation of the client as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicities can be submitted for the client.
Code Values:
10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)
   11 = Mexican, Mexican American, Chicano/a
   12 = Puerto Rican
   13 = Cuban
   14 = Other Hispanic, Latino/a, or Spanish Origin
20 = No, Not Hispanic or Latino/a, or Spanish Origin
Other Instructions:
The code values allow for more or less specificity to be submitted. If the person is of Hispanic or Latino/a or Spanish origin but the specific ethnicity is not known, submit code value 10.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Ethnicity Element #: Clt9
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: English Competency Element #: Clt10
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The client's ability to communicate using the English language.
Code Values:
1 = Very Well
2 = Well
3 = Not Well
4 = Not at all
Other Instructions:
This assessment is based upon the social worker's judgment or other assessment instruments used by the agency staff.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: English Competency Element #: Clt10
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Primary Language Element #: Clt11
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The primary language or method that the client uses for written and verbal communication.
Code Values:
1 = Arabic
2 = Chinese
3 = English
4 = French
5 = German
6 = Korean
7 = Russian
8 = Spanish or Spanish Creole
9 = Tagalog
10 = Vietnamese
11 = Sign Language
12 = Assistive Technology
13 = Other
Other Instructions:
If a person is fluent in more than one language or method of communication, choose the primary language the person uses with agency staff.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Primary Language Element #: Clt11
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Marital Status Element #: Clt12
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The client's status based on state residency laws.
Code Values:
1 = Never Married
2 = Married
3 = Domestic Partner, Including Civil Union
4 = Divorced
5 = Separated
6 = Widowed
7 = Other
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Marital Status Element #: Clt12
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Schooling Level Element #: Clt13
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The highest educational degree attained by the client.
Code Values:
1 = Less than High School
2 = High School Diploma or Equivalent
3 = Associate's Degree or Bachelor's Degree
4 = Advanced Degree
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Schooling Level Element #: Clt13
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Employment Status Element #: Clt14
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The involvement of the client in the labor force.
Code Values:
1 = Employed
2 = Unemployed
3 = Not in Labor Force
4 = Other
Other Instructions:
If client is retired but also employed, use Code 1. If client is participating in sheltered workshops or work centers for sub-minimum wages, use code value 4.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Employment Status Element #: Clt14
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Income Level Element #: Clt15
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The level of annual income of the client including all sources of income.
Code Values:
1 = Less than $25,000
2 = $25,000-$49,999
3 = $50,000-$74,999
4 = $75,000-$99,999
5 = $100,000 or More
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Income Level Element #: Clt15
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Benefits Element #: Clt16
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The federal and state benefits received by the client during the investigation. Multiple values can be submitted.
Code Values:
1 = Medicaid
2 = Medicare
3 = Publicly-Subsidized Housing
4 = SSDI
5 = Social Security Retirement Benefits
6 = SSI
7 = TANF
8 = Veterans' Disabled Benefits
9 = Other
10 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Benefits Element #: Clt16
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Veteran Status Element #: Clt17
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The client's status related to the U.S. Armed Forces.
Code Values:
1 = Veteran
2 = Non-Veteran
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Coments:

 

Entity: Client
Element Name: Veteran Status Element #: Clt17
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Disabilities Element #: Clt18
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
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 disabilities can be submitted for the client.
Code Values:
1 = Ambulatory Difficulty
2 = Cognitive Difficulty
3 = Hearing Difficulty
4 = Independent Living Difficulty
5 = Self-care Difficulty
6 = Vision Difficulty
7 = Other
8 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Disabilities Element #: Clt18
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: ADL Score Element #: Clt19
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The client's score on the Katz Index of Independence in ADLs.
Code Values:
Permissible values are 0-6.
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: IADL Score Element #: Clt20
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The client's score on the Lawton IADLs.
Code Values:
Permissible values are 0-8.
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Behavioral Health Screenings Element #: Clt21
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The results of screening assessments on the client, conducted by the APS agency. Multiple results can be submitted for the client.
Code Values:
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
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Behavioral Health Screenings Element #: Clt21
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Behavioral Health Diagnoses Element #: Clt22
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The results of assessments on the client, conducted by medical or clinical professionals. Multiple results can be submitted for the client.
Code Values:
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
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Behavioral Health Diagnoses Element #: Clt22
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Living Setting at Start Element #: Clt23
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The primary residential environment of the client at the start of investigation.
Code Values:
10 = Own Residence or Residence of Relative or Caregiver
20 = Residential Care Community Setting (non-specific)
   21 = Licensed Residential Care Community Setting
   22 = Non-licensed Residential Care Community Setting
30 = Nursing Home (non-specific)
   31 = Licensed Nursing Home
   32 = Non-licensed Nursing Home
40 = Other
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the nursing home is licensed, submit Code 31. If the license status is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Living Setting at Start Element #: Clt23
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Living Setting at Close Element #: Clt24
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The primary residential environment of the person at the time of case closure.
Code Values:
10 = Own Residence or Residence of Relative or Caregiver
20 = Residential Care Community Setting (non-specific)
   21 = Licensed Residential Care Community Setting
   22 = Non-licensed Residential Care Community Setting
30 = Nursing Home (non-specific)
   31 = Licensed Nursing Home
   32 = Non-licensed Nursing Home
40 = Other
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the nursing home is licensed, submit Code 31. If the license status is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Living Setting at Close Element #: Clt24
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Substitute Decision Makers at Start Element #: Clt25
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The authorizations that are in effect related to health, personal, or financial decision making for the client at the start of the investigation. Multiple Substitute Decision Makers can be submitted for the client.
Code Values:
10 = Health Care Proxy in Effect
20 = Financial Proxy in Effect
30 = Guardianship or Conservatorship (non-specific)
   31 = Guardianship or Conservatorship of Person
   32 = Guardianship or Conservatorship of Property
40 = Representative Payee
50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Substitute Decision Makers at Start Element #: Clt25
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Substitute Decision Makers at Close Element #: Clt26
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The authorizations that are in effect related to health, personal, or financial decision making for the client at time of case closure. Multiple Substitute Decision Makers can be submitted for the client.
Code Values:
10 = Health Care Proxy in Effect
20 = Financial Proxy in Effect
30 = Guardianship or Conservatorship (non-specific)
   31 = Guardianship or Conservatorship of Person
   32 = Guardianship or Conservatorship of Property
40 = Representative Payee
50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Substitute Decision Makers at Close Element #: Clt26
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Services at Start Element #: Clt27
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
Element Description:
The services known to the agency that the client was already receiving at the start of the investigation.
Code Values:
1 = Care/Case Management Services
2 = Caregiver Support Services
3 = Community Day Services
4 = Education, Employment, and Training Services
5 = Emergency Assistance and Material Aid Services
6 = Financial Planning Services
7 = Housing and Relocation Services
8 = In-home Assistance Services
9 = Legal Services
10 = Medical and Dental Services
11 = Medical Rehabilitation Services
12 = Mental Health Services
13 = Nutrition
14 = Public Assistance Benefits
15 = Substance Use Services
16 = Transportation
17 = Victim Services
18 = Other Services
19 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Services at Start Element #: Clt27
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Services APS Element #: Clt27
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
Element Description:
The services which the agency provided on behalf of the client during the investigation or while the agency kept an open case.
Code Values:
1 = Care/Case Management Services
2 = Caregiver Support Services
3 = Community Day Services
4 = Education, Employment, and Training Services
5 = Emergency Assistance and Material Aid Services
6 = Financial Planning Services
7 = Housing and Relocation Services
8 = In-home Assistance Services
9 = Legal Services
10 = Medical and Dental Services
11 = Medical Rehabilitation Services
12 = Mental Health Services
13 = Nutrition
14 = Public Assistance Benefits
15 = Substance Use Services
16 = Transportation
17 = Victim Services
18 = Other Services
19 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Services APS Element #: Clt27
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Services Referred Element #: Clt29
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
Element Description:
The services for which the agency referred the client.
Code Values:
1 = Care/Case Management Services
2 = Caregiver Support Services
3 = Community Day Services
4 = Education, Employment, and Training Services
5 = Emergency Assistance and Material Aid Services
6 = Financial Planning Services
7 = Housing and Relocation Services
8 = In-home Assistance Services
9 = Legal Services
10 = Medical and Dental Services
11 = Medical Rehabilitation Services
12 = Mental Health Services
13 = Nutrition
14 = Public Assistance Benefits
15 = Substance Use Services
16 = Transportation
17 = Victim Services
18 = Other Services
19 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Services Referred Element #: Clt29
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Services at Close Element #: Clt30
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
Element Description:
The services known to the agency that the client was receiving at the time of case closure.
Code Values:
1 = Care/Case Management Services
2 = Caregiver Support Services
3 = Community Day Services
4 = Education, Employment, and Training Services
5 = Emergency Assistance and Material Aid Services
6 = Financial Planning Services
7 = Housing and Relocation Services
8 = In-home Assistance Services
9 = Legal Services
10 = Medical and Dental Services
11 = Medical Rehabilitation Services
12 = Mental Health Services
13 = Nutrition
14 = Public Assistance Benefits
15 = Substance Use Services
16 = Transportation
17 = Victim Services
18 = Other Services
19 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Services at Close Element #: Clt30
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Interagency Coordination Element #: Clt31
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 11/20/2014
Element Description:
The agencies to which the client was referred.
Code Values:
1 = Law Enforcement or Prosecutorial Offices
2 = Protection and Advocacy or CAP
3 = State Licensing Agency
4 = State MFCU
5 = Long-Term Care Ombudsman Program
6 = Other
7 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Interagency Coordination Element #: Clt31
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Previous Report Element #: Clt32
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The indication that the agency has information that the client was the subject of a previous report.
Code Values:
1 = Yes
2 = No
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Previous Report Element #: Clt32
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client
Element Name: Maltreatment Setting Element #: Clt33
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The location where alleged maltreatment occurred.
Code Values:
10 = Own Residence or Private Residence of Relative or Caregiver
20 = Residential Care Community Setting (non-specific)
   21 = Licensed Residential Care Community Setting
   22 = Unlicensed Residential Care Community Setting
30 = Nursing Home (non-specific)
   31 = Licensed Nursing Home
   32 = Unlicensed Nursing Home
40 = Adult Day Services Center (non-specific)
   41 = Licensed Adult Day Services Center
   42 = Unlicensed Adult Day Services Center
50 = Place of Business or Other Services
60 = Other
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example if the nursing home is licensed submit Code 31. If the license status is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client
Element Name: Maltreatment Setting Element #: Clt33
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

G.3. Maltreatment

Entity: Maltreatment
Element Name: Maltreatment Type Element #: Mal1
Type: Numeric Size: 1 Required: Yes Quantifier: Single Last Revised: 12/17/2014
Element Description:
The alleged maltreatments that are investigated.
Code Values:
1 = Abandonment
2 = Emotional Abuse
3 = Financial Exploitation
4 = Neglect
5 = Physical Abuse
6 = Sexual Abuse
7 = Suspicious Death
8 = Self-neglect
9 = Other
Other Instructions:
Each maltreatment entity has only a single maltreatment type.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Maltreatment
Element Name: Maltreatment Type Element #: Mal1
Type: Numeric Size: 1 Required: Yes Quantifier: Single Last Revised: 12/17/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Maltreatment
Element Name: Maltreatment Disposition Element #: Mal2
Type: Numeric Size: 1 Required: Yes Quantifier: Single Last Revised: 12/5/2014
Element Description:
The disposition of each alleged maltreatment.
Code Values:
1 = Substantiated
2 = Inconclusive
3 = Unsubstantiated
4 = Other
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Maltreatment
Element Name: Maltreatment Disposition Element #: Mal2
Type: Numeric Size: 1 Required: Yes Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

G.4. Perpetrator

Entity: Perpetrator
Element Name: Perpetrator ID Element #: Per1
Type: Numeric Size: 32 Required: Yes Quantifier: Single Last Revised: 12/17/2014
Element Description:
The unique ID used by the state for the person who is found to be responsible for substantiated maltreatment(s). The ID is assigned to a specific perpetrator and is used to identify the same perpetrator across investigations and reporting. The Perpetrator Identifier is encrypted or encoded by the state for purposes of data submission.
Code Values:
Not applicable.
Other Instructions:
Data on multiple substantiated perpetrators for each client can be submitted for the investigation.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Age Element #: Per2
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The age of the perpetrator in years (at investigation start date).
Code Values:
18,19...74 = Actual Age
75 = 75-84
85 = 85 and older
Other Instructions:
The Perpetrator Age is computed by subtracting the perpetrator date of birth from the Investigation Start Date. If the age ranges between 18 and 74, the actual age is used. Age of 75-84 inclusive are grouped and coded as 75. Ages of 85 or older are grouped and coded as 85.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Gender Identity Element #: Per3
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The actual or perceived gender-related characteristics of the perpetrator.
Code Values:
1 = Male
2 = Female
3 = Transgender
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Gender Identity Element #: Per3
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Perpetrator
Element Name: Race Element #: Per4
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The population(s) or group(s) that the perpetrator identifies as being a member. Multiple races can be submitted for the perpetrator.
Code Values:
10 = American Indian or Alaska Native
20 = Asian (non-specific)
   21 = Asian Indian
   22 = Chinese
   23 = Filipino
   24 = Japanese
   25 = Korean
   26 = Vietnamese
   27 = Other Asian
30 = Black or African American
40 = Native Hawaiian or Other Pacific Islander (non-specific)
   41 = Native Hawaiian
   42 = Guamanian or Chamorro
   43 = Samoan
   44 = Other Pacific Islander
50 = White
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example if the perpetrator is Asian of Filipino and Japanese descent, only submit Code 23 and Code 24. Do not submit Code 20.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Race Element #: Per4
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Perpetrator
Element Name: Ethnicity Element #: Per5
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The affiliation of the perpetrator as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicities can be submitted for the perpetrator.
Code Values:
10 = Yes, Hispanic or Latino/a, or Spanish Origin (non-specific)
   11 = Mexican, Mexican American, Chicano/a
   12 = Puerto Rican
   13 = Cuban
   14 = Other Hispanic, Latino/a, or Spanish Origin
20 = No, Not Hispanic or Latino/a, or Spanish Origin
Other Instructions:
The code values allow for more or less specificity to be submitted. If the person is of Hispanic or Latino/a or Spanish origin but the specific ethnicity is not known, submit code value 10.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Ethnicity Element #: Per5
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Perpetrator
Element Name: Disabilities Element #: Per6
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The perpetrator'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 disabilities can be submitted for the perpetrator.
Code Values:
1 = Ambulatory Difficulty
2 = Cognitive Difficulty
3 = Hearing Difficulty
4 = Independent Living Difficulty
5 = Self-care Difficulty
6 = Vision Difficulty
7 = Other
8 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Disabilities Element #: Per6
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Perpetrator
Element Name: Behavioral Health Screenings Element #: Per7
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The results of screening assessments on the perpetrator, conducted by the APS agency. Multiple results can be submitted for the perpetrator.
Code Values:
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
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Behavioral Health Screenings Element #: Per7
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Perpetrator
Element Name: Behavioral Health Diagnoses Element #: Per8
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The results of assessments on the perpetrator, conducted by medical or clinical professionals. Multiple results can be submitted for the perpetrator.
Code Values:
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
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Perpetrator
Element Name: Behavioral Health Diagnoses Element #: Per8
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

G.5. Client Perpetrator Relationship

Entity: Client-Perpetrator Relationship
Element Name: Cohabitation at Start Element #: CPR1
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The indication if the perpetrator and victim are cohabitating at the start of the investigation.
Code Values:
1 = Yes
2 = No
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Cohabitation at Start Element #: CPR1
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Cohabitation at Close Element #: CPR2
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The indication if the perpetrator and client are cohabitating at the time of case closure.
Code Values:
1 = Yes
2 = No
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Cohabitation at Close Element #: CPR2
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Kinship Relationship Element #: CPR3
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 11/20/2014
Element Description:
The indication if the perpetrator is related to the client by affinity (blood, adoption, marriage, etc.)
Code Values:
10 = Yes (not specific)
   11 = Spouse
   12 = Domestic Partner, including Civil Union
   13 = Parent
   14 = Child
   15 = Sibling
   16 = Grandparent
   17 = Grandchild
   18 = Other Relative
20 = None
Other Instructions:
The code values allow for specific kinship to be submitted if known. If the perpetrator is kin to the client but the specific kinship is not known, use code value 10.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Kinship Relationship Element #: CPR3
Type: Numeric Size: 2 Required: No Quantifier: Single Last Revised: 11/20/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Association at Start Element #: CPR4
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The indication if the perpetrator has a caregiving relationship to the client at the start of the investigation.
Code Values:
1 = Nursing Home Staff
2 = Residential Care Community Staff
3 = Paid Formal Caregiver
4 = Paid Informal or Family Caregiver
5 = Unpaid Informal or Family Caregiver
6 = Other Relationship
7 = None
Other Instructions:
If the perpetrator has multiple associations to the client, choose primary association.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Association at Start Element #: CPR4
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Association at Close Element #: CPR5
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
Element Description:
The indication whether the perpetrator has a caregiving relationship to the client at time of case closure.
Code Values:
1 = Nursing Home Staff
2 = Residential Care Community Staff
3 = Paid Formal Caregiver
4 = Paid Informal or Family Caregiver
5 = Unpaid Informal or Family Caregiver
6 = Other Relationship
7 = None
Other Instructions:
If the perpetrator has multiple associations to the client, choose primary association.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Association at Close Element #: CPR5
Type: Numeric Size: 1 Required: No Quantifier: Single Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Substitute Decision Maker at Start Element #: CPR6
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
Authorizations that the perpetrator has in relation to the victim, and that are in effect, related to health, personal or financial decision making at the start of the investigation.
Code Values:
10 = Health Care Proxy in Effect
20 = Financial Proxy in Effect
30 = Guardianship or Conservatorship (non-specific)
   31 = Guardianship or Conservatorship of Person
   32 = Guardianship or Conservatorship of Property
40 = Representative Payee
50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Substitute Decision Maker at Start Element #: CPR6
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Substitute Decision Maker at Close Element #: CPR7
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
Authorizations that the perpetrator has in relation to the victim, and that are in effect, related to health, personal or financial decision making at the time of case closure.
Code Values:
10 = Health Care Proxy in Effect
20 = Financial Proxy in Effect
30 = Guardianship or Conservatorship (non-specific)
   31 = Guardianship or Conservatorship of Person
   32 = Guardianship or Conservatorship of Property
40 = Representative Payee
50 = None
Other Instructions:
The code values allow for more or less specificity to be submitted. The highest level of specificity that is known should be submitted. For example, if the guardianship is specifically for the person submit Code 31. If the specificity is not known, submit Code 30.
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Substitute Decision Maker at Close Element #: CPR7
Type: Numeric Size: 2 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Legal Remedy Element #: CPR8
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 12/5/2014
Element Description:
The legal remedies that were sought by the APS agency regarding the status of the perpetrator.
Code Values:
1 = Removal of Guardianship Rights
2 = Restraining Order on Perpetrator Regarding the Victim
3 = Eviction of Perpetrator
4 = Restitution by Perpetrator
5 = Other Legal Remedy
6 = None
Other Instructions:
 
State Data Information:
Can the state provide data for this element? ___ Yes ___ No
 
State File/Table Name: State Field/Element Name:
 
Comments:

 

Entity: Client-Perpetrator Relationship
Element Name: Perpetrator Legal Remedy Element #: CPR8
Type: Numeric Size: 1 Required: No Quantifier: Multiple Last Revised: 12/5/2014
State File/
Table Name
State Field/
Element Name
State Code Value State Code
Description/Name
NAMRS Code
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Enter NAMRS Code Values NOT Included:

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