Template Downloads

CSV templates with headers and sample rows for all schemas

About Templates

Each template includes:

• Header row with all field names in the correct order
• Sample row with realistic example data

Copy the header row to start building your submission file. Refer to the corresponding schema page for field-level details and validation rules.

Core Schema Templates

CLIENT Template (CLI)

Client demographics and identifiers. 32 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_CLIENT_IDENTIFIER|EFFECTIVE_DATE|STATE_IDENTIFIER|TRAILS_IDENTIFIER|VERATO_IDENTIFIER|BHA_IDENTIFIER|DOB|LAST_NAME|FIRST_NAME|MIDDLE_NAME_INITIAL|NAME_SUFFIX|SSN|COUNTY_RESIDENCE|ZIPCODE_RESIDENCE|RACE_CODES|ETHNICITY|HOUSEHOLD_LANGUAGE|SEX_AT_BIRTH|GENDER_IDENTITY|SEXUAL_ORIENTATION|CHILD_WELFARE_INVOLVEMENT|DISABILITY_CODES|VETERANS_STATUS|LAST_KNOWN_ADDRESS_LINE_1|LAST_KNOWN_ADDRESS_LINE_2|LAST_KNOWN_CITY|RAE_REGION|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
CLI|A|CLT-000001|2024-07-15|A123456||||1990-05-15|Smith|Jane|M||123-45-6789|31|80202|05|05||01||01|0|01|0|123 Main St||Denver|3|2024-07-15 10:30:00|system|2024-07-15 10:30:00

ADMISSION Template (ADM)

Treatment episode admission records. 38 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_CLIENT_IDENTIFIER|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|LEGACY_ADMISSION_IDENTIFIER|LOCATION_NPI|ADMISSION_DATE|SERVICE_IDENTIFIER|FIRST_CONTACT_DATE|FIRST_APPOINTMENT_OFFERED_DATE|MEDICATION_ASSISTED_OPIOID_THERAPY|REFERRAL_SOURCE|ARRESTS_PAST_30_DAYS|EMPLOYMENT_STATUS|MARITAL_STATUS|LIVING_SITUATION|MONTHLY_INCOME|PRIMARY_INCOME_SOURCE|PREGNANCY_STATUS|WITHIN_1_YEAR_POSTPARTUM_STATUS|SPECIAL_CONNECTIONS_ENROLLMENT|ACT_ENROLLMENT|ASCENT_ENROLLMENT|NUMBER_DEPENDENT_CHILDREN|SELF_HELP_ATTENDANCE|TOTAL_SUBSTANCE_USE_PRIOR_TREATMENT|PSYCHIATRIC_HOSPITAL_ADMISSION|LEGAL_STATUS|INVOLUNTARY_REASON|CRIMINAL_JUSTICE_INVOLVEMENT|EDUCATION_LEVEL|SCHOOL_ATTENDANCE|PSYCHIATRIC_ER_VISIT_6_MONTHS|COMMUNICATION_ACCOMMODATIONS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
ADM|A|CLT-000001|ADM-000001|2024-07-15||1234567890|2024-07-15|01|2024-07-01|2024-07-08|0|01|0|01|01|01||01|0|0|0|0|0|0|0|0||01|||12|2|0||2024-07-15 10:30:00|system|2024-07-15 10:30:00

DISCHARGE Template (DIS)

Treatment episode discharge records. 18 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|LAST_CONTACT_DATE|DISCHARGE_DATE|DISCHARGE_STATUS|END_OF_TREATMENT_REASON|ARRESTS_PAST_30_DAYS|EMPLOYMENT_STATUS|LIVING_SITUATION|SELFHELP_ATTENDANCE|EDUCATION_LEVEL|SCHOOL_ATTENDANCE|LEGAL_STATUS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
DIS|A|ADM-000001|2024-12-15|2024-12-10|2024-12-15|01||0|01|01|4|12|2|01|2024-12-15 10:30:00|system|2024-12-15 10:30:00

Clinical Data Templates

DIAGNOSIS Template (DXA/DXD)

Clinical diagnoses at admission and discharge. 12 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|MH_DIAGNOSIS_ID_1|MH_DIAGNOSIS_ID_2|MH_DIAGNOSIS_ID_3|SUD_DIAGNOSIS_ID|SMI_SED_STATUS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
DXA|A|ADM-000001|2024-07-15|F32.1||||01|2024-07-15 10:30:00|system|2024-07-15 10:30:00

SUBSTANCE USE Template (SIA/SID)

Substance use information at admission and discharge. 20 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|ASAM_LEVEL_OF_CARE|PRIMARY_SUBSTANCE_USE|PRIMARY_LAST_USED_30_DAYS|PRIMARY_ROUTE_OF_USE|PRIMARY_START_AGE|SECONDARY_SUBSTANCE_USE|SECONDARY_LAST_USED_30_DAYS|SECONDARY_ROUTE_OF_USE|SECONDARY_START_AGE|TERTIARY_SUBSTANCE_USE|TERTIARY_LAST_USED_30_DAYS|TERTIARY_ROUTE_OF_USE|TERTIARY_START_AGE|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
SIA|A|ADM-000001|2024-07-15||02|15|01|16|00||||00||||2024-07-15 10:30:00|system|2024-07-15 10:30:00

Specialized Program Templates

ACT Template

Assertive Community Treatment quarterly data. 13 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|ASSESSMENT_COMPLETION_DATE|QTR_PSYCH_ER_DAYS|QTR_JAIL_DOC_DAYS|ACT_DISCHARGE_DATE|ACT_DISCHARGE_OUTCOME|COMMENTS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
ACT|A|ADM-000001|2024-07-15|2024-09-30|0|0||||2024-07-15 10:30:00|system|2024-07-15 10:30:00

ASCENT Template (ASA/ASQ/ASD)

Youth residential treatment data — admission, quarterly update, and discharge record types. 43 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|PROGRAM|ASCENT_ADMISSION_DATE|REFERRAL_SOURCE|FIRST_EPISODE_DATE|ASSESSMENT_COMPLETION_DATE|CURRENT_EDUCATION_STATUS|QOL|SOCIAL_FUNCTIONING|ROLE_FUNCTIONING|MCSI_1|MCSI_2|MCSI_3|MCSI_4|MCSI_5|MCSI_6|MCSI_7|MCSI_8|MCSI_9|MCSI_10|MCSI_11|MCSI_12|MCSI_13|MCSI_14|ENGAGEMENT_WITH_PROGRAM|FAMILY_AND_OR_SUPPORT_SYSTEM|PRIOR_SUICIDE_ATTEMPTS|QTR_SUICIDE_ATTEMPTS|PRIOR_PSYCH_HOSP_DAYS|QTR_PSYCH_HOSP_DAYS|PRIOR_WIC_DAYS|QTR_WIC_DAYS|ANTIPSYCHOTIC_MEDS|STAGE_OF_CHANGE|DISCHARGE_DATE|DISCHARGE_OUTCOME|COMMENTS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
ASA|A|ADM-000001|2024-07-15|01|2024-07-15|01|2024-01-15|2024-09-30|01|01|01|01|01|01|01|01|01|01|01|01|01|01|01|01|01|01|01||0|0|||||01|||||2024-07-15 10:30:00|system|2024-07-15 10:30:00

SC BABY Template (BAB)

Special Connections baby outcomes. 15 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|BHASO_BABY_IDENTIFIER|LIVE_BIRTH|DOB|WEIGHT_LBS|WEIGHT_OZ|LAST_NAME|FIRST_NAME|MIDDLE_NAME_INITIAL|SEX_AT_BIRTH|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
BAB|A|ADM-000001|2024-12-01|BABY-ID-01|1|2024-12-01|07|06|Smith|Baby|J|01|2024-12-01 10:30:00|system|2024-12-01 10:30:00

SC PREGNANCY RISK Template (PRS)

Special Connections pregnancy risk assessment. 25 columns.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|EVALUATION_DATE|CHRONOLOGICAL_AGE|FREQUENCY_DRUGALCOHOL_USE|PREGNANCY_POSTPARTUM_STATUS|PREGNANCY_POSTPARTUM_CARE_STATUS|DRUGALCOHOL_TREATMENT_ACCESS|FAMILY_SOCIAL_SUPPORT|FAMILY_SUD_HISTORY|FAMILY_SUD_CURRENT|DRUG_USING_PARTNER|HIV_RISK|HOME_STABILITY_SAFETY|PERSONAL_SAFETY|PRIOR_CRIMINAL_RECORD|MENTAL_HEALTH_HISTORY|PRIOR_DRUGALCOHOL_TREATMENT|CHILDREN_LIVING_WITH_CLIENT|CHILDREN_AGES_LIVING_WITH_CLIENT|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
PRS|A|ADM-000001|2024-07-15|2024-07-15|01|01|01|01|01|01|01|01|01|01|01|01|01|01|01|1|01|2024-07-15 10:30:00|system|2024-07-15 10:30:00

Recommendation — This section contains guidance developed by the documentation team to supplement the CoBHRM specification. Reviewers should evaluate whether to adopt, modify, or remove this content.

Template Usage Guide

Step 1: Copy the Header Row

Expand the template for the schema you need and copy the first line (the header row).

Step 2: Review Field Requirements

Refer to the corresponding schema documentation for each field’s requirement level:

• R = Required field
• C = Conditionally required field
• O = Optional field

Step 3: Prepare Your Data

1. Paste the header row as the first line of your CSV file
2. Map your data to the template columns
3. Ensure all required fields have values
4. Check conditional requirements

Step 4: Validate Format

Before submitting:

• File is saved as UTF-8 CSV
• All required fields have values
• Date fields are in YYYY-MM-DD format
• Code values match Appendix A

Template Format

All submissions follow this format:

# Row 1: Column headers
RECORD_TYPE|TRANSACTION_TYPE|BHASO_CLIENT_IDENTIFIER|...

# Row 2+: Your data rows
CLI|A|CLT-000001|...

Submit only the header row and your data rows. Do not include sample data or comment rows.

Recommendation — This section contains guidance developed by the documentation team to supplement the CoBHRM specification. Reviewers should evaluate whether to adopt, modify, or remove this content.

Troubleshooting

Common Template Issues

Issue	Solution
Column mismatch error	Use the official template headers — don’t rename or reorder columns
Encoding error	Save as UTF-8, not UTF-16 or ANSI
Extra columns	Remove any columns not in the template
Missing header row	First row must be the column headers

Recommendation — This section contains guidance developed by the documentation team to supplement the CoBHRM specification. Reviewers should evaluate whether to adopt, modify, or remove this content.

Excel Users

When saving from Excel:

1. Go to File > Save As
2. Choose “CSV UTF-8 (Comma delimited)” format
3. If this option isn’t available, use “CSV (Comma delimited)” and check encoding

Excel exports use comma delimiters by default. After exporting from Excel, you must replace all commas with pipe (|) delimiters before submitting to CoBHRM. Consider using a text editor’s find-and-replace or a scripting language for this conversion.

Consider using a text editor or scripting language for large files. Excel may modify data unexpectedly (e.g., removing leading zeros, changing date formats).