MIECHV Data Element Name Applicable Form(s): Applicable  Roles: Description of MIECHV Data Element Data Type CHAMP PH-DOC CareFacts
PrimaryKey All Forms All Roles The unique individual identifier for a MIECHV client. MIECHV-specific      
FName Intake All Roles   Demographic First_name CLIENT_FIRST_NAME ClientFirstName 
LName Intake All Roles   Demographic Last_name CLIENT_LAST_NAME ClientLastName
MInitial Intake All Roles   Demographic Middle_initial CLIENT_MIDDLE_NAME ClientMiddleInitial
DBirth Intake All Roles   Demographic Born_on CLIENT_BIRTHDATE ClientBirthDate
ID Intake All Roles Alternate identifier for locating records in other applications (public health software, Efforts to Outcomes, WIC, etc.) MIECHV-specific      
Type All Forms All Roles Identifies type of participant client:
Infant/child, Primary Caregiver, Prenatal or Postpartum		 MIECHV-specific      
Site All Forms All Roles Identifies Site performing client home visits.  Site is not necessarily the same as the local public health agency funding the home visiting services.  Site may be subcontractor. MIECHV-specific      
DForm All Forms All Roles Date an individual form was completed MIECHV-specific      
DFirstHV All Forms All Roles Date of the client's first home visit        
Race Intake All Roles   Demographic race RACE_CODE ClientPrimaryRaceSC
RaceSpec Intake All Roles Specify Race if Other or More than 1 Demographic      
Ethnicity Intake All Roles Yes=Hispanic Demographic ethnicity ETHNICITY_CODE ClientEthnicitySC
Gender Intake All Roles   Demographic gender CLIENT_SEX ClientGenderSC
MedRes Intake
6/12 Month		 All Roles Medical Resources (insurance, MA, etc)   pay_source
medicare_no
medicaid_no		   InsuranceCompany
AgencyPayorMedicareID
AgencyPayorMedicaidID
MedResSpec Intake
6/12 Month		 All Roles Specify if Medical Resources = Other or More than 1        
Insure Intake
6/12 Month		 All Roles Insurance status of mother and child        
WellCare Intake
6/12 Month		 Infant/Child Has child had Well Care checkup?        
DWellCare Intake
6/12 Month		 Infant/Child Date of Well Care checkup        
WellCare50 Intake
6/12 Month		 Infant/Child Has child had at least 50% of Well Care checkups?        
WksPreg Intake Prenatal Number of weeks pregnant at first visit        
WksPpm Intake Postpartum Number of weeks postpartum at first visit        
FTM Intake Postpartum First time mother?        
PrimLang Intake All Roles Primary language spoken in house Demographic language_1 LANGUAGE_CODE ClientPrimarySpokenLanguageSC
PrimLangSpec Intake All Roles Specify Language if Other Demographic      
EducProg Intake
6/12 Month		 All Adult Roles completed any educational programs or classes in the past 12 months        
EducProgSpec Intake
6/12 Month		 All Adult Roles If EducProg = Yes, specify        
EducHS Intake
6/12 Month		 All Adult Roles Completed High School?   education_level   ClientEducationSpecialtyMSC
EducLG Intake
6/12 Month		 All Adult Roles If EducHS = No, last grade completed   education_level   ClientEducationSpecialtyMSC
EducADV Intake
6/12 Month		 All Adult Roles If EducHS = Yes, highest level of educational attainment in addition to HS diploma or GED   education_level   ClientEducationSpecialtyMSC
Smoke Intake
6/12 Month		 PCG & Postpartum Change in smoking status during pregnancy?
6/12 Month only asks Prenatal		       MaternalHealthSmokeCigarettesSC
MaternalHealthCigarettesPerDaySC
Income Intake
6/12 Month		 PCG & Postpartum Monthly total household income and benefits        
ERUrgent Intake
6/12 Month		 All Adult Roles ER/Urgent care visit in last 6 months       OasisCM2300_EMERGENCY_USE_AFTR_LAST_ASSESSMENT
DeprSrn Intake
6/12 Month		 PCG & Postpartum Screened for possible depression?       (MCH Client)AssessmentEmotionalStabilityM1730_STANDARDISED_DEPRESSION_SCREENING
MaternalHealthClientScreenedForDepressionAbuseSC
OasisCM1730_STANDARDISED_DEPRESSION_SCREENING
(Pathway Assessment)AssessmentEmotionalStabilityM1730_STANDARDISED_DEPRESSION_SCREENING
NCAST Intake
6/12 Month		 PCG & Postpartum Was NCAST assessment completed by 3 mos. post-delivery?        
NCASTI Intake
6/12 Month		 PCG & Postpartum Parent support for children's learning and development        
NCASTII Intake
6/12 Month		 PCG & Postpartum Parent support for children's learning and development        
NCASTIII Intake
6/12 Month		 PCG & Postpartum Parent behaviors and parent-child relationships        
NCASTIV Intake
6/12 Month		 PCG & Postpartum Parent behaviors and parent-child relationships        
NCASTV Intake
6/12 Month		 PCG & Postpartum Parent support for children's learning and development        
NCASTVI Intake
6/12 Month		 PCG & Postpartum Parent support for children's learning and development        
Ftype 6/12 Month All Roles Is this a 6 or 12 month followup? MIECHV-specific      
ICBM 6/12 Month Infant/Child Is infant/child continuing to receive breastmilk?       PregnancyIsMotherBreastfeedingSC
ICBMS 6/12 Month Infant/Child How old was infant/child when stopped receiving breastmilk?        
NCAST12 6/12 Month PCG & Postpartum Was NCAST assessment completed by 12 mos. post-delivery?        
NCASTI12 6/12 Month PCG & Postpartum Parent support for children's learning and development        
NCASTII12 6/12 Month PCG & Postpartum Parent support for children's learning and development        
NCASTIII12 6/12 Month PCG & Postpartum Parent behaviors and parent-child relationships        
NCASTIV12 6/12 Month PCG & Postpartum Parent behaviors and parent-child relationships        
NCASTV12 6/12 Month PCG & Postpartum Parent support for children's learning and development        
NCASTVI12 6/12 Month PCG & Postpartum Parent support for children's learning and development        
FOLIC 6/12 Month Prenatal Taking vitamin/supplement containing folic acid?       PregnancyIsClientTakingPrenatalVitaminsSC
Mo24 Assmt/Referral Infant/Child Was the child 24 months of age or older during the reporting period?        
WA Assmt/Referral Infant/Child At the child's most recent health assessment, what was the  child's weight? (Round to the nearest pound.)   child_weight_lbs
child_weight_oz		   VisitWeight
VitalSignWeight
HA Assmt/Referral Infant/Child At the child's most recent health assessment, what was the  child's height? (Round to the nearest inch.)   child_length_inches   ClientHeight
VisitHeight
VitalSignHeight
EDev Assmt/Referral Infant/Child Was infant/child ELIGIBLE for developmental screening  using ASQ during report period?        
SDev Assmt/Referral Infant/Child Was infant/child SCREENED for developmental milestones using ASQ, during  report period?        
MDev Assmt/Referral Infant/Child Did infant/child MEET developmental milestones at most recent screening during report period?        
RDev Assmt/Referral Infant/Child Was infant/child REFERRED to community resources for not meeting developmental milestones at their most recent screening for further assessment and/or services?           
SADev Assmt/Referral Infant/Child Did infant/child RECIEVE FURTHER ASSESSMENT and/or SERVICES for which participant was referred to for not meeting developmental milestones?        
ESE Assmt/Referral Infant/Child Was infant/child ELIGIBLE for social-emotional screening using ASQ:SE, during  report period?        
SSE Assmt/Referral Infant/Child Was infant/child SCREENED for social-emotional milestones using ASQ:SE, during report period?        
MSE Assmt/Referral Infant/Child Did infant/child MEET social-emotional milestones at most recent screening during report period?        
RSE Assmt/Referral Infant/Child Was infant/child REFERRED to community resources for not meeting social-emotional milestones at most recent screening for further assessment and/or services?        
SASE Assmt/Referral Infant/Child Did infant/child RECEIVE FURTHER ASSESSMENT and/or SERVICES for which participant was referred to for not meeting social-emotional milestones?        
SCM Assmt/Referral Infant/Child Was infant/child screened and assessed for possible child maltreatment during report period?        
CMR Assmt/Referral Infant/Child Did infant/child have a substantiated child maltreatment report from Child Protection Agency records, during report period?        
CMF Assmt/Referral Infant/Child Was child a first-time victim of child maltreatment, as reported by Child Protection Agency?        
EPPD Assmt/Referral All Adult Roles Was participant eligible for postpartum depression symptom screen  during report period?        
SPPD Assmt/Referral All Adult Roles Was participant screened for postpartum depression within 6-8 weeks postpartum, during report period?       (MCH Client)AssessmentEmotionalStabilityM1730_STANDARDISED_DEPRESSION_SCREENING
MaternalHealthClientScreenedForDepressionAbuseSC
OasisCM1730_STANDARDISED_DEPRESSION_SCREENING
(Pathway Assessment)AssessmentEmotionalStabilityM1730_STANDARDISED_DEPRESSION_SCREENING
PPPD Assmt/Referral All Adult Roles Did this participant screen positive for possible postpartum depression?        
SDV Assmt/Referral All Adult Roles Was  participant screened for domestic violence using standardized assessment tool during report period?       MaternalHealthClientScreenedForDomesticAbuseSC
PDV Assmt/Referral All Adult Roles Was participant identified for the presence of domestic violence?        
RDV Assmt/Referral All Adult Roles Was this participant referred to relevant domestic violence services?        
SPDV Assmt/Referral All Adult Roles Did the participant have a safety plan completed?        
HSC Assmt/Referral All Adult Roles Did this participant have a Home Safety Checklist completed during the reporting period?        
ReQ Service Untilization All Adult Roles Was this participant referred to the MIECHV home visiting program during the current quarter? MIECHV-specific      
EnQ Service Untilization All Adult Roles Was this participant enrolled in the MIECHV home visiting program? MIECHV-specific      
RD Service Untilization All Adult Roles Reason for dismissal MIECHV-specific      
DQ Service Untilization All Adult Roles Did this participant leave the program during the current quarter? MIECHV-specific      
DDischarge Service Untilization All Adult Roles Date of discharge MIECHV-specific      
RDisc Service Untilization All Adult Roles Reason for leaving the program MIECHV-specific      
RDiscSpec Service Untilization All Adult Roles Specify reason for leaving the program MIECHV-specific