Medical Mental Health Reference Data. Florida Safe Families Network FSFN. May 12, 2017 Page 1 FSFN. Medical Mental Health. Page: Tab Name: Field Name:
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1 Mental Health Profile Alcohol, Drugs, Marijuana, Solvents Frequency Daily Isolated Known Use / Unknown Frequency Occasional/Monthly Use Weekly Medical History Condition Type Dental Medical Mental Medical History Provider Type Allergy AODA Counselor Audiology Bariatrics Cardiology Dental Exam Dental/General Dentistry Dental/Oral Surgery Dental/Orthodontics Dermatology Page 1
2 Ear, Nose & Throat Medicine Emergency Medicine Endocrinology Family Practice Gastroenterology General Surgery Hematology Neurology Nutritionist Obstetrics-Gynecology Oncology Ophthalmology/Eye Surgery Orthopedic Other Pathology Pediatrics Physical Exam Podiatry Prosthetic Services Psychiatry Pulmonary Medicine Reconstructive Medicine Urology Medical History Type of Service Acute Off Site Visit Acute On Site Visit Page 2
3 Acute/Inpatient Counseling Annual Foster Child Dental Exam Annual Foster Child Physical Exam Behavior Management Specialist Chemical Dependency Counseling Child Protective Exam/CPC Child Protective Exam Chronic Off Site Visit Chronic On Site Visit Crisis Intervention Day Treatment Dental Exam EPSDT (Or Initial Medical) Family Counseling Follow-Up Visit Group Counseling Gynecological Exam Health Screen/CPC Health Screen Individual Counseling Lab Work Other Physical Exam Physical Health Counseling Pre-Natal Residential Treatment Screening and Testing Sex Offender Counseling Special Needs Counseling Treatment Foster Care Page 3
4 Victimization Counseling Yearly Check-up Disability Information Has the child been clinically diagnosed as having a disability(ies)? Yes No Not Yet Determined Note: Disability Information Diagnosed Condition Category/Diagnosed Condition Type The Diagnosed Condition Category will drive the Diagnosed Condition Type values. Behavioral/Mental Health ADD ADHD Adjustment Disorders Agoraphobia Anorexia Nervosa Antisocial Personality Disorder Anxiety Disorders Attention Deficit and Disruptive Disorders Avoidant Personality Disorder Bipolar Disorder Borderline Personality Disorder Bulimia Conduct Disorder Cyclothymic Disorder Page 4
5 Delusional Disorder Dependent Personality Disorder Depressive Disorders Dysthymic Disorder Eating Disorders Histrionic Personality Disorder Impulse Control Disorder Mood Disorders Obsessive Compulsive Disorder Obsessive Compulsive Personality Disorder Oppositional Defiant Disorder Panic Disorder including Generalized Panic Disorder Paranoid Personality Disorder Personality Disorders Phobias Post Traumatic Stress Disorder (PTSD) Psychotic Disorder Reactive Attachment Disorder Schizoaffective Disorder Schizoid Personality Disorder Schizophrenaform Disorder Schizophrenia Schizophrenic and Other Psychotic Disorders Schizotypal Personality Disorder Separation Anxiety Disorder Somatoform Disorder Tourette Syndrome Page 5
6 Intellectual/Developmental Asperger's Syndrome Autistic Disorder Borderline Intellectual Functioning Childhood Disintegrative Disorder Down Syndrome Hydrocephalus Intellectual Disability (Mental Retardation, all degrees) Learning Disability Microcephaly Pervasive Developmental Disorders Not Otherwise Specified Rett Syndrome Medical/Physical Acquired Immunodeficiency Syndrome (AIDS) Aplastic Anemia Arthritis Asthma* Blindness and Low Vision (ICD-9 369) Blood disorder that required hospitalization once a month Brittle Bones/Osteogenesis Imperfectus Cancers Cataracts Cerebral Palsy Chronic Granulomatous Disease Chronic Motor Tic Disorder Cleft palate Club Foot Page 6
7 Coagulation Defects Congenital anomaly of the eye Congenital cystic lung Congenital heart anomaly Crohn's disease Cushing's syndrome Cystic Fibrosis Deaf Diabetes Diabetic Retinopathy Diplegia Disorders Involving The Immune Mechanism (code 279) Encephalopathy Epilepsy Fetal alcohol syndrome Fetal drug addiction Glaucoma Hearing Loss (ICD-9 389) Heart disease Heart murmur, vigorous activity curtailed Hemophilia Human Immunodeficiency HIV Disease (HIV) Human T-Cell Lymphotropic Virus-III Hypertension Immunodeficiency Kidney disease Klienefelter's syndrome Late Effects Of Tuberculosis (ICD-9 137) Page 7
8 Leukemia Liver disease Lupus Malignant Neoplasms (Malignant tumors) Misplaced facial feature Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Organic Brain Syndrome Other Human T-Cell Lymphotropic Virus-III Pancreatic Disease Paralysis - Paraplegic, Quadriplegic, Diplegic Poliomyelitis Retinal Detachment and Defects (ICD-9 361) Rheumatoid Arthritis (juvenile) Sarcomas Seizure Disorder Sickle cell anemia Spina bifida Visual Disturbances (ICD-9 368) Disability Information Emotionally Disturbed; Learning Disability; Visually or Hearing Impaired; Physically Disabled; Other Medical Condition; Drug Abuse; Mental Retardation; Alcohol Abuse Yes No Unknown Page 8
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