what_is_your_gender_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: Other (please specify): - 2. What is your gender?, type: esriFieldTypeString
)
what_is_your_race_or_ethnicity
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 3. What is your race or ethnicity? (select all that apply), type: esriFieldTypeString
)
what_is_your_race_or_ethn_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: Other (please specify): - 3. What is your race or ethnicity? (select all that apply), type: esriFieldTypeString
)
what_language_do_you_speak
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 4. What language do you speak?, type: esriFieldTypeString
)
what_language_do_you_spea_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: Other (please specify): - 4. What language do you speak?, type: esriFieldTypeString
)
which_of_the_items_below_descri
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 5. Which of the items below describe where you live?, type: esriFieldTypeString
, Coded Values:
[City: City]
, [Suburbs: Suburbs]
, [Rural area: Rural area]
, ...7 more...
)
what_is_your_current_employment
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 6. What is your current employment status?, type: esriFieldTypeString
, Coded Values:
[Employed full-time: Employed full-time]
, [Employed part-time: Employed part-time]
, [Unemployed and looking for work: Unemployed and looking for work]
, ...4 more...
)
what_is_your_current_empl_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: Other (please specify): - 6. What is your current employment status?, type: esriFieldTypeString
)
what_is_the_highest_level_of_sc
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 7. What is the highest level of school you have completed?, type: esriFieldTypeString
, Coded Values:
[Some high school: Some high school]
, [High school graduate or GED: High school graduate or GED]
, [Some college: Some college]
, ...4 more...
)
what_is_the_highest_level_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: Other (please specify): - 7. What is the highest level of school you have completed?, type: esriFieldTypeString
)
have_you_ever_gone_to_the_emerg
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 9. Have you ever gone to the Emergency Room for mental health or substance-use issues?, type: esriFieldTypeString
, Coded Values:
[No: No]
, [Yes: Yes]
)
if_yes_how_long_ago_did_you_vis
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If Yes, how long ago did you visit?, type: esriFieldTypeString
, Coded Values:
[Within the last month: Within the last month]
, [Within the last 3 months: Within the last 3 months]
, [Within the last 6 months: Within the last 6 months]
, ...2 more...
)
have_you_gone_to_the_emergency
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 10. Have you gone to the Emergency Room more than once in the last 12 months?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
)
why_did_you_go_to_the_emergency
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 11. Why did you go to the Emergency Room for mental health or substance-use help?, type: esriFieldTypeString
)
how_can_the_department_of_behav
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 12. How can the Department of Behavioral Health or your clinic help so you don't need to go to the Emergency Room for mental health or substance use problems?, type: esriFieldTypeString
)
are_you_getting_services_for_yo
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: Are you getting services for your mental health or substance-use issues?, type: esriFieldTypeString
)
can_you_easily_contact_the_clin
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: Can you easily contact the clinic to make or cancel appointments?, type: esriFieldTypeString
)
field_32
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: Write any problems you have when contacting the clinic and the clinic name:, type: esriFieldTypeString
)
do_you_know_where_to_get_help_f
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: Do you know where to get help for mental healthor substance-use problems in a crisis, either at your clinic or elsewhere?, type: esriFieldTypeString
)
do_you_know_how_to_contact_thes
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: Do you know how to contact these places when you need them?, type: esriFieldTypeString
)
what_do_you_think_dbh_can_do_to
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 17. What do you think DBH can do to help you keep up with follow-up care right after visiting the Emergency Department?, type: esriFieldTypeString
)
what_is_the_name_and_address_of
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is the name and address of the clinic you go to?, type: esriFieldTypeString
)
why_didnt_you_go_to_your_appoin
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Why didn't you go to your appointment?, type: esriFieldTypeString
)
field_39
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 13. Are you currently getting services for mental health or substance-use?, type: esriFieldTypeString
, Coded Values:
[No: No]
, [Yes: Yes]
)
field_40
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 15. Can you easily contact the clinic to make or cancel appointments?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
)
field_42
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 16. Do you know where to get help for mental health or substance-use problems in a crisis, either at your clinic or elsewhere?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
)
field_43
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Do you know how to contact these places when you need them?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
)
_13_were_you_getting_services_i
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 14. Were you getting services (i.e., individual therapy or case management) at the time of your Emergency Room visit?, type: esriFieldTypeString
, Coded Values:
[Yes: Yes]
, [No: No]
)
why_did_you_go_to_the_eme_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: other reason: - 11. Why did you go to the Emergency Room for mental health or substance-use help?, type: esriFieldTypeString
)
_18_is_there_anything_else_you
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 18. Is there anything else you want us to know?, type: esriFieldTypeString
)
field_51_other
(
nullable: true, editable: true, defaultValue: , length: 255, alias: Other - My clinic is:, type: esriFieldTypeString
)