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Client Service Receipt Inventory Form

0 Shared Subjects

The Client Service Receipt Inventory (CSRI) is a research instrument to collect information on service utilization, income, accommodation and other cost-related variables. It’s primary purpose is to allow resource use patterns to be described and support costs to be estimated using an appropriate unit cost. Beecham J, Knapp M. Costing psychiatric interventions. In Measuring Mental Health Needs, Second Edition (ed. Thornicroft G.): 200–24. Gaskell, 2001
Clinical Assessments
Questionnaire
02/10/2021
clientsri01
07/19/2023
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported
clientsri01 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker 0;1 0 = No; 1 = Yes
clientsri02 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker - If yes, number of contacts in past 3 months
clientsri03 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker - If yes, average amount of money spent on travel
clientsri04 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker - If yes, average time waiting to be seen (in minutes)
clientsri05 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker - If yes, average time to travel (round trip in minutes)
clientsri06 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker - If yes, average time spent with provider (in minutes)
clientsri07 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Health Worker - If yes, average fee per visit
clientsri08 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor 0;1 0 = No; 1 = Yes
clientsri09 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor - If yes, number of contacts in past 3 months
clientsri10 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor - If yes, average amount of money spent on travel
clientsri11 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor - If yes, average time waiting to be seen (in minutes)
clientsri12 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor - If yes, average time to travel (round trip in minutes)
clientsri13 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor - If yes, average time spent with provider (in minutes)
clientsri14 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Community Based Doctor - If yes, average fee per visit
clientsri15 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist 0;1 0 = No; 1 = Yes
clientsri16 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist - If yes, number of contacts in past 3 months
clientsri17 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist - If yes, average amount of money spent on travel
clientsri18 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist - If yes, average time waiting to be seen (in minutes)
clientsri19 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist - If yes, average time to travel (round trip in minutes)
clientsri20 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist - If yes, average time spent with provider (in minutes)
clientsri21 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatrist - If yes, average fee per visit
clientsri22 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist 0;1 0 = No; 1 = Yes
clientsri23 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist - If yes, number of contacts in past 3 months
clientsri24 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist - If yes, average amount of money spent on travel
clientsri25 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist - If yes, average time waiting to be seen (in minutes)
clientsri26 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist - If yes, average time to travel (round trip in minutes)
clientsri27 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist - If yes, average time spent with provider (in minutes)
clientsri28 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychologist - If yes, average fee per visit
clientsri29 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse 0;1 0 = No; 1 = Yes
clientsri30 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse - If yes, number of contacts in past 3 months
clientsri31 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse - If yes, average amount of money spent on travel
clientsri32 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse - If yes, average time waiting to be seen (in minutes)
clientsri33 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse - If yes, average time to travel (round trip in minutes)
clientsri34 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse - If yes, average time spent with provider (in minutes)
clientsri35 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Psychiatric Nurse - If yes, average fee per visit
clientsri36 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker 0;1 0 = No; 1 = Yes
clientsri37 Integer Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker - If yes, number of contacts in past 3 months
clientsri38 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker - If yes, average amount of money spent on travel
clientsri39 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker - If yes, average time waiting to be seen (in minutes)
clientsri40 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker - If yes, average time to travel (round trip in minutes)
clientsri41 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker - If yes, average time spent with provider (in minutes)
clientsri42 Float Recommended Have you had contact with any of these community health services in the last 3 months? - Social Worker - If yes, average fee per visit
clientsri43 Integer Recommended Have you had to stay in a hospital in the last 3 months? 0;1 0 = No; 1 = Yes
clientsri44 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, was it planned or unplanned? 1;2 1 = Planned; 2 = Unplanned
clientsri45 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Mental health ward 0;1 0 = No; 1 = Yes
clientsri46 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Mental health ward - Number of nights:
clientsri47 Float Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Mental health ward - Total out of pocket cost (if any):
clientsri48 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Other health ward 0;1 0 = No; 1 = Yes
clientsri49 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Other health ward - Number of nights:
clientsri50 Float Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Other health ward - Total out of pocket cost (if any):
clientsri51 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Acute Psychiatric Ward 0;1 0 = No; 1 = Yes
clientsri52 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Acute Psychiatric Ward - Number of nights:
clientsri53 Float Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Acute Psychiatric Ward - Total out of pocket cost (if any):
clientsri54 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Long Stay Psychiatric Ward 0;1 0 = No; 1 = Yes
clientsri55 Integer Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Long Stay Psychiatric Ward - Number of nights:
clientsri56 Float Recommended Have you had to stay in a hospital in the last 3 months? - If yes, what hospital service did you use? - Long Stay Psychiatric Ward - Total out of pocket cost (if any):
clientsri57 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? 0;1 0 = No; 1 = Yes
clientsri58 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Accident and emergency service 0;1 0 = No; 1 = Yes
clientsri59 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Accident and emergency service - Number of visits in the last three months:
clientsri60 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Psychiatric Outpatient Service 0;1 0 = No; 1 = Yes
clientsri61 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Psychiatric Outpatient Service - Number of visits in the last three months:
clientsri62 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Other (Non-Psychiatric) Outpatient Service 0;1 0 = No; 1 = Yes
clientsri63 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Other (Non-Psychiatric) Outpatient Service - Number of visits in the last three months:
clientsri64 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Day hospital 0;1 0 = No; 1 = Yes
clientsri65 Integer Recommended Have you been to outpatient services at a hospital in the last 3 months? - If yes, what hospital service did you use? - Day hospital - Provide total number of days in the last three months
clientsri66 Integer Recommended In the last 3 months, have you taken any medicines for your mental health? 0;1 0 = No; 1 = Yes
clientsri67 String 150 Recommended In the last 3 months, have you taken any medicines for your mental health? - If yes, Name/description of drug:
clientsri68 Integer Recommended In the last 3 months, have you taken any medicines for your mental health? - If yes, how was it acquired? 1;2 1 = Paid; 2 = Free
clientsri69 String 50 Recommended In the last 3 months, have you taken any medicines for your mental health? - If yes, dosage of medicine:
clientsri70 Integer Recommended In the last 3 months, have you taken any medicines for your mental health? - If yes, dosage frequency: 1::7 1 = 3 times daily; 2 = 2 times daily; 3 = Once daily; 4 = Weekly; 5 = Every 2 weeks; 6 = Monthly; 7 = Less than once per month
clientsri71 Integer Recommended In the past 3 months, have you used traditional health / complementary medicine services? 0;1 0 = No; 1 = Yes
clientsri72 String 50 Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, name of service provider:
clientsri73 Integer Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, number of contacts in past 3 months:
clientsri74 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, average amount of money spent on travel:
clientsri75 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, average time waiting to be seen (in minutes):
clientsri76 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, average time to travel (round trip in minutes):
clientsri77 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, average time spent with provider (in minutes):
clientsri78 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - A. If yes, average fee per visit:
clientsri79 String 50 Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, name of service provider:
clientsri80 Integer Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, number of contacts in past 3 months:
clientsri81 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, average amount of money spent on travel:
clientsri82 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, average time waiting to be seen (in minutes):
clientsri83 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, average time to travel (round trip in minutes):
clientsri84 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, average time spent with provider (in minutes):
clientsri85 Float Recommended In the past 3 months, have you used traditional health / complementary medicine services? - B. If yes, average fee per visit:
clientsri86 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? 0;1 0 = No; 1 = Yes
clientsri87 String 150 Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, please give details:
clientsri88 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, how many days in the last 3 months? (Patient)
clientsri89 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, type of work foregone? (Patient) 1::3 1 = unpaid housework (e.g. housewife); 2 = manual work (e.g. agricultural or factory worker); 3 = office / non-manual work (e.g. skilled worker, business, professional)
clientsri90 Float Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, income lost per day? (Patient)
clientsri91 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, how many days in the last 3 months? (Family/friend 1)
clientsri92 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, type of work foregone? (Family/friend 1) 1::3 1 = unpaid housework (e.g. housewife); 2 = manual work (e.g. agricultural or factory worker); 3 = office / non-manual work (e.g. skilled worker, business, professional)
clientsri93 Float Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, income lost per day? (Family/friend 1)
clientsri94 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, how many days in the last 3 months? (Family/friend 2)
clientsri95 Integer Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, type of work foregone? (Family/friend 2) 1::3 1 = unpaid housework (e.g. housewife); 2 = manual work (e.g. agricultural or factory worker); 3 = office / non-manual work (e.g. skilled worker, business, professional)
clientsri96 Float Recommended In the last 3 months, have you or a family member or friend had to stop or reduce usual work / activities due to your ill-health? If yes, income lost per day? (Family/friend 2)
pn_csri_2b Integer Recommended If you have been admitted to the hospital in the last 6 months, many times were you admitted?
pn_csri_3a Integer Recommended In the last 6 months, have you had any X-rays, Blood Tests, ECG, ultrasound, scans or any other tests? 0;1 0 = No; 1 = Yes
pn_csri_3b Integer Recommended If in the last 6 months, you have had any X-rays, Blood Tests, ECG, ultrasound, scans or any other test, how many tests have you had?
pn_csri_4a Integer Recommended In the last 6 months, have you taken tablets, medicines or injections? 0;1 0 = No; 1 = Yes
pn_csri_5a Integer Recommended Has your child had any contact with out-patient health care services? 0;1 0 = No; 1 = Yes
pn_csri_5_1 Integer Recommended Has your child had contact with a lady health worker? 0;1 0 = No; 1 = Yes
pn_csri_5_2 Integer Recommended Has your child had contact with a Primary Health Care provider? 0;1 0 = No; 1 = Yes
pn_csri_5_3 Integer Recommended Has your child had contact with a lady health visitor? 0;1 0 = No; 1 = Yes
pn_csri_5_4 Integer Recommended Has your child had contact with a community midwife? 0;1 0 = No; 1 = Yes
pn_csri_5_5 Integer Recommended Has your child had contact with a private doctor? 0;1 0 = No; 1 = Yes
pn_csri_6a Integer Recommended Has your child been admitted to the hospital in the last 6 months? 0;1 0 = No; 1 = Yes
pn_csri_6b Integer Recommended If your child has been admitted to the hospital in the last 6 months, many times were they admitted?
pn_csri_7a Integer Recommended In the last 6 months, has your child had any X-rays, Blood Tests, ECG, ultrasound, scans or any other tests? 0;1 0 = No; 1 = Yes
pn_csri_7b Integer Recommended If in the last 6 months, your child has had any X-rays, Blood Tests, ECG, ultrasound, scans or any other test, how many tests have they had?
pn_csri_8a Integer Recommended In the last 6 months, has your child taken tablets, medicines or injections? 0;1 0 = No; 1 = Yes
timepoint_label String 50 Recommended Timepoint/visit label
pn_csri_1a Integer Recommended Have you had any contact with out-patient health care services? 0;1 0 = No; 1 = Yes
pn_csri_1_1 Integer Recommended Have you had contact with a lady health worker? 0;1 0 = No; 1 = Yes
pn_csri_1_2 Integer Recommended Have you had contact with a Primary Health Care provider? 0;1 0 = No; 1 = Yes
pn_csri_1_3 Integer Recommended Have you had contact with a lady health visitor? 0;1 0 = No; 1 = Yes
pn_csri_1_4 Integer Recommended Have you had contact with a community midwife? 0;1 0 = No; 1 = Yes
pn_csri_1_5 Integer Recommended Have you had contact with a private doctor? 0;1 0 = No; 1 = Yes
pn_csri_2a Integer Recommended Have you been admitted to the hospital in the last 6 months? 0;1 0 = No; 1 = Yes
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
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