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Standard Code Book (SCB)  

Health Factors

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Code Category Health Factor Code Health Factor Standards Outcome
C005  DIABETES SELF MONITORING  F032  YES  Use Diabetes self-monitoring to document whether patient perform self-monitoring of blood glucose (blood sugar testing) at home. 1. Ask whether the patient checks blood glucose at home. 2. Document the health facotr screening using the associated health factor codes.  Patient performs self-monitoring of blood glucose 
C014  OCCUPATION  F104  WORKS WITH FOOD  Use Occupation to identify various qualities of the patient's occupation that may influence health outcomes. 1. Ask the patient what type of job he or she does. 2. Ask the patient what hours he or she works. 3. Ask the patient if there are any risks involved in his or her work. 4. Document the health factor screening results using the associated health factor codes. More than one health factor can be documented for the patient.  Works with food preparation or raw meats 
C014  OCCUPATION  F103  WORKS WITH ANIMALS  Use Occupation to identify various qualities of the patient's occupation that may influence health outcomes. 1. Ask the patient what type of job he or she does. 2. Ask the patient what hours he or she works. 3. Ask the patient if there are any risks involved in his or her work. 4. Document the health factor screening results using the associated health factor codes. More than one health factor can be documented for the patient.  Works with animals 
C009  BARRIERS TO LEARNING  F058  VISUALLY IMPAIRED  Barriers to learning are patient specific. They usually are not visit specific, but rather relate to the patient's overall health status. Assess barriers by observation and interview, and then document them to alert other healthcare providers who may provide education. It is important to accommodate and overcome barriers to enhance patient learning. Assess barriers annually or any time the situation warrents assessment. 1. Observe and question the patient for any barriers to learning. a.Visually Impaired - The patient may divert the eyes, squint, or state his or her difficulty seeing. b.Blind - The patient may divert the eyes, wear sunglasses inside, state his or her inability to see, or is diagnosed with blindness (best corrected vision is =20/200 or =20 degrees of visual field in the better eye). c.Hard of Hearing - The patient may not respond to questions initially and may ask for things to be repeated, may speak loudly, bend ear or lean toward the speaker, or wear a hearing device. d. Deaf - The patient may not respond to questions, may look intently at your lips as you speak, may motion to communicate by writing, may use sign language to indicate deafness, or may have a diagnosis of deafness. e.Doesn't Read English - Ask the patient or the patient’s family about his or her ability to read English. The patient may be embarrassed to admit he or she cannot read English or may make excuses such as “I forgot my glasses.” This is a sensitive subject and must be treated accordingly. Stress “English” in this evaluation and acknowledge that the patient’s primary language may be unwritten. Another technique is to have the patient read a sentence that could be interpreted in different ways and ask the patient how he or she interprets the sentence. If the patient is unable, state that reading English can be hard for people who learned another language first and ask if this applies to him or her. f.Speaks English as a Second Language - The patient speaks English fluently, but may have minor barriers due to differences in primary language. g.Interpreter Needed - The patient may verbalize the need for an interpreter, answer questions inappropriately, or answer or nod “yes” to all questions. These actions could also imply hearing difficulty and may require further assessment. h.Fine Motor Skills Deficit - The patient may have difficulty or lack the physical control to direct or manage body movement, such as paralysis, arthritis, amputation, unable to handle testing supplies (for example checking blood sugars or measuring medications). i.Dementia - The patient may answer questions inappropriately, behave inappropriately, or display symptoms of confusion or forgetfulness. The patient may have a documented diagnosis of dementia. j.Values or Beliefs - The patient may comment or be asked about values or beliefs in relation to health information or medical or clinical aspects of health care. k.Stressors - The patient may appear distraught, avoid eye contact, or show anger. The emotional stressors may be acute or ongoing. e.g., personal issues (marital/relationship problems, unemployment/financial stress, lack of housing, problems with children/family members) or behavioral issues (mood, anxiety, grief). Emotional stressors are internal while social stressors are external. l.Low Health Literacy - Assessment is made by a low score on a health literacy screening tool or observation. m.Cognitive Impairment - The patient may be unable to give return demonstration, fails to understand simple information despite multiple attempts to teach, or has a diagnosis of cognitive impairment. n.Developmental Delay - (DO NOT USE) The patient may behave younger than actual age. o.Learning Disability - (DO NOT USE) The patient may comment about a learning disability or be diagnosed as such. p.Childhood Development - (DO NOT USE) The pediatric patient is of an age or cognition level that he or she relies on others for care. q.Less than 6th Grade Education - (DO NOT USE) Must assess by asking grade level completed. r.Social Stressors - (DO NOT USE) The patient may appear distraught, avoid eye contact, or show anger. The stressors may be acute or ongoing, as in the case of conflict, mental disorders, disease, death, alcohol or substance abuse, or domestic violence. Social stressors are external while emotional stressors are internal. 2. Document the health factor screening results using the associated health factor codes.  The patient has difficulty seeing even with best corrected vision. The difficulty can be compensated with the use of other measures, devices, or both to improve vision (large print, better lighting, magnifying glasses). 
C010  ASTHMA TRIGGERS  F073  VIRAL INFECTION  1. Ask the patient if exposure to any of the associated health factors worsen asthma symptoms. 2. Document the asthma trigger health factors using the associated health factor codes. When necessary, add multiple health factors (to document that the patient has more than one asthma trigger: mold, dust mites and animals).  Viral infections worsen the patient’s asthma status. 
C012  CONFIDENCE IN MANAGING HEALTH PROBLEMS  F092  VERY SURE  Use this health factor to assess the likeliness that the patient will take an active role in managing their health and well being. 1.Ask the patient, "How sure are you that you can manage and control most of your health problems." 2.Document the health factor screening results using the associated health factor codes.   The patient is confident that they can take an active role and manage most of their health problems. The patient is very likely to achieve their health goals.  
C011  ACTIVITY LEVEL  F087  VERY ACTIVE  Use Activity level to document the average amount of physical activity in which the patient engages. 1. Ask the patient if he or she engages in physical activity. 2. Ask the patient in what activities he or she is engaged. 3. Ask the patient how much time he or she spends engaging in this activity. 4. Document the health factor screening results using the associated health factor codes.  For patients age 18 and over: Engages in 300 or more minutes of physical activity per week to achieve and maintain a healthy body weight and reduce body fat (For patients age 6-17: 420 or more) 
C009  BARRIERS TO LEARNING  F053  VALUES/BELIEFS  Barriers to learning are patient specific. They usually are not visit specific, but rather relate to the patient's overall health status. Assess barriers by observation and interview, and then document them to alert other healthcare providers who may provide education. It is important to accommodate and overcome barriers to enhance patient learning. Assess barriers annually or any time the situation warrents assessment. 1. Observe and question the patient for any barriers to learning. a.Visually Impaired - The patient may divert the eyes, squint, or state his or her difficulty seeing. b.Blind - The patient may divert the eyes, wear sunglasses inside, state his or her inability to see, or is diagnosed with blindness (best corrected vision is =20/200 or =20 degrees of visual field in the better eye). c.Hard of Hearing - The patient may not respond to questions initially and may ask for things to be repeated, may speak loudly, bend ear or lean toward the speaker, or wear a hearing device. d. Deaf - The patient may not respond to questions, may look intently at your lips as you speak, may motion to communicate by writing, may use sign language to indicate deafness, or may have a diagnosis of deafness. e.Doesn't Read English - Ask the patient or the patient’s family about his or her ability to read English. The patient may be embarrassed to admit he or she cannot read English or may make excuses such as “I forgot my glasses.” This is a sensitive subject and must be treated accordingly. Stress “English” in this evaluation and acknowledge that the patient’s primary language may be unwritten. Another technique is to have the patient read a sentence that could be interpreted in different ways and ask the patient how he or she interprets the sentence. If the patient is unable, state that reading English can be hard for people who learned another language first and ask if this applies to him or her. f.Speaks English as a Second Language - The patient speaks English fluently, but may have minor barriers due to differences in primary language. g.Interpreter Needed - The patient may verbalize the need for an interpreter, answer questions inappropriately, or answer or nod “yes” to all questions. These actions could also imply hearing difficulty and may require further assessment. h.Fine Motor Skills Deficit - The patient may have difficulty or lack the physical control to direct or manage body movement, such as paralysis, arthritis, amputation, unable to handle testing supplies (for example checking blood sugars or measuring medications). i.Dementia - The patient may answer questions inappropriately, behave inappropriately, or display symptoms of confusion or forgetfulness. The patient may have a documented diagnosis of dementia. j.Values or Beliefs - The patient may comment or be asked about values or beliefs in relation to health information or medical or clinical aspects of health care. k.Stressors - The patient may appear distraught, avoid eye contact, or show anger. The emotional stressors may be acute or ongoing. e.g., personal issues (marital/relationship problems, unemployment/financial stress, lack of housing, problems with children/family members) or behavioral issues (mood, anxiety, grief). Emotional stressors are internal while social stressors are external. l.Low Health Literacy - Assessment is made by a low score on a health literacy screening tool or observation. m.Cognitive Impairment - The patient may be unable to give return demonstration, fails to understand simple information despite multiple attempts to teach, or has a diagnosis of cognitive impairment. n.Developmental Delay - (DO NOT USE) The patient may behave younger than actual age. o.Learning Disability - (DO NOT USE) The patient may comment about a learning disability or be diagnosed as such. p.Childhood Development - (DO NOT USE) The pediatric patient is of an age or cognition level that he or she relies on others for care. q.Less than 6th Grade Education - (DO NOT USE) Must assess by asking grade level completed. r.Social Stressors - (DO NOT USE) The patient may appear distraught, avoid eye contact, or show anger. The stressors may be acute or ongoing, as in the case of conflict, mental disorders, disease, death, alcohol or substance abuse, or domestic violence. Social stressors are external while emotional stressors are internal. 2. Document the health factor screening results using the associated health factor codes.  The patient has values or beliefs that may impact learning; this may also include traditional Native American/Alaska Native values or beliefs that may impact the medical or clinical aspects of healthcare. 
C014  OCCUPATION  F114  UNEMPLOYED  Use Occupation to identify various qualities of the patient's occupation that may influence health outcomes. 1. Ask the patient what type of job he or she does. 2. Ask the patient what hours he or she works. 3. Ask the patient if there are any risks involved in his or her work. 4. Document the health factor screening results using the associated health factor codes. More than one health factor can be documented for the patient.  Currently not employed 
C003  TB STATUS  F029  TX UNTREATED  Use Tuberculosis treatment status to document TB treatment status in affected patients. 1. Evaluate patient for history of TB or positive PPD test. 2. Determine if the patient has active or a history of infection or exposure. 3. Document health factor screening results using the associated health factor codes.  TB has not been treated 
C003  TB STATUS  F028  TX UNKNOWN  Use Tuberculosis treatment status to document TB treatment status in affected patients. 1. Evaluate patient for history of TB or positive PPD test. 2. Determine if the patient has active or a history of infection or exposure. 3. Document health factor screening results using the associated health factor codes.  Status of TB treatment is uncertain 
C003  TB STATUS  F027  TX INCOMPLETE  Use Tuberculosis treatment status to document TB treatment status in affected patients. 1. Evaluate patient for history of TB or positive PPD test. 2. Determine if the patient has active or a history of infection or exposure. 3. Document health factor screening results using the associated health factor codes.  Patient has not completed a course of TB treatment 
C003  TB STATUS  F105  TX IN PROGRESS  Use Tuberculosis treatment status to document TB treatment status in affected patients. 1. Evaluate patient for history of TB or positive PPD test. 2. Determine if the patient has active or a history of infection or exposure. 3. Document health factor screening results using the associated health factor codes.  Patient is currently receiving TB treatment 
C003  TB STATUS  F026  TX COMPLETE  Use Tuberculosis treatment status to document TB treatment status in affected patients. 1. Evaluate patient for history of TB or positive PPD test. 2. Determine if the patient has active or a history of infection or exposure. 3. Document health factor screening results using the associated health factor codes.  Patient has completed a course of TB treatment 
C020  REPRODUCTIVE PLAN   F128  TRYING TO CONCEIVE  These health factors support reproductive planning and implement improvement projects around preconception care. This drives education and interventions such as folate intake, counseling and selection of contraception, and tobacco use cessation interventions to improve healthier pregnancies and reduce unwanted pregnancies.  The patient is actively planning and trying to become pregnant if female, or father a child if male, in the next year. 
C010  ASTHMA TRIGGERS  F066  TOBACCO SMOKE  1. Ask the patient if exposure to any of the associated health factors worsen asthma symptoms. 2. Document the asthma trigger health factors using the associated health factor codes. When necessary, add multiple health factors (to document that the patient has more than one asthma trigger: mold, dust mites and animals).  The patient’s asthma status worsens when exposed to tobacco smoke. 
C008  LEARNING PREFERENCE  F044  TALK  List Learning Preference in the medical record as a health factor. Although a patient may have a predominant way of learning, it is important to use a variety of teaching methods to optimize an educational encounter. Evaluate learning preference whenever it seems necessary. 1. Review the most common styles of adult learning (talking and asking questions, group discussion, videos, reading). 2. Explain that every individual is unique and has his or her own preference(s) in how they receive new information. 3. Ask the patient, or the patient's family, 'How do you learn best?' 4. Document the health factor screening results using the associated health factor codes.  The patient, or the patient’s family, states that talking and asking questions is a preferred style of learning. 
C010  ASTHMA TRIGGERS  F072  STRONG EMOTIONAL EXPRESSION  1. Ask the patient if exposure to any of the associated health factors worsen asthma symptoms. 2. Document the asthma trigger health factors using the associated health factor codes. When necessary, add multiple health factors (to document that the patient has more than one asthma trigger: mold, dust mites and animals).  Strong emotional expressions cause worsening of the patient’s asthma status. 
C009  BARRIERS TO LEARNING  F077  STRESSORS  Barriers to learning are patient specific. They usually are not visit specific, but rather relate to the patient's overall health status. Assess barriers by observation and interview, and then document them to alert other healthcare providers who may provide education. It is important to accommodate and overcome barriers to enhance patient learning. Assess barriers annually or any time the situation warrents assessment. 1. Observe and question the patient for any barriers to learning. a.Visually Impaired - The patient may divert the eyes, squint, or state his or her difficulty seeing. b.Blind - The patient may divert the eyes, wear sunglasses inside, state his or her inability to see, or is diagnosed with blindness (best corrected vision is =20/200 or =20 degrees of visual field in the better eye). c.Hard of Hearing - The patient may not respond to questions initially and may ask for things to be repeated, may speak loudly, bend ear or lean toward the speaker, or wear a hearing device. d. Deaf - The patient may not respond to questions, may look intently at your lips as you speak, may motion to communicate by writing, may use sign language to indicate deafness, or may have a diagnosis of deafness. e.Doesn't Read English - Ask the patient or the patient’s family about his or her ability to read English. The patient may be embarrassed to admit he or she cannot read English or may make excuses such as “I forgot my glasses.” This is a sensitive subject and must be treated accordingly. Stress “English” in this evaluation and acknowledge that the patient’s primary language may be unwritten. Another technique is to have the patient read a sentence that could be interpreted in different ways and ask the patient how he or she interprets the sentence. If the patient is unable, state that reading English can be hard for people who learned another language first and ask if this applies to him or her. f.Speaks English as a Second Language - The patient speaks English fluently, but may have minor barriers due to differences in primary language. g.Interpreter Needed - The patient may verbalize the need for an interpreter, answer questions inappropriately, or answer or nod “yes” to all questions. These actions could also imply hearing difficulty and may require further assessment. h.Fine Motor Skills Deficit - The patient may have difficulty or lack the physical control to direct or manage body movement, such as paralysis, arthritis, amputation, unable to handle testing supplies (for example checking blood sugars or measuring medications). i.Dementia - The patient may answer questions inappropriately, behave inappropriately, or display symptoms of confusion or forgetfulness. The patient may have a documented diagnosis of dementia. j.Values or Beliefs - The patient may comment or be asked about values or beliefs in relation to health information or medical or clinical aspects of health care. k.Stressors - The patient may appear distraught, avoid eye contact, or show anger. The emotional stressors may be acute or ongoing. e.g., personal issues (marital/relationship problems, unemployment/financial stress, lack of housing, problems with children/family members) or behavioral issues (mood, anxiety, grief). Emotional stressors are internal while social stressors are external. l.Low Health Literacy - Assessment is made by a low score on a health literacy screening tool or observation. m.Cognitive Impairment - The patient may be unable to give return demonstration, fails to understand simple information despite multiple attempts to teach, or has a diagnosis of cognitive impairment. n.Developmental Delay - (DO NOT USE) The patient may behave younger than actual age. o.Learning Disability - (DO NOT USE) The patient may comment about a learning disability or be diagnosed as such. p.Childhood Development - (DO NOT USE) The pediatric patient is of an age or cognition level that he or she relies on others for care. q.Less than 6th Grade Education - (DO NOT USE) Must assess by asking grade level completed. r.Social Stressors - (DO NOT USE) The patient may appear distraught, avoid eye contact, or show anger. The stressors may be acute or ongoing, as in the case of conflict, mental disorders, disease, death, alcohol or substance abuse, or domestic violence. Social stressors are external while emotional stressors are internal. 2. Document the health factor screening results using the associated health factor codes.  The patient’s ability to learn is limited due to emotional stressors. 
C014  OCCUPATION  F102  STAFF EMPLOYEE  Use Occupation to identify various qualities of the patient's occupation that may influence health outcomes. 1. Ask the patient what type of job he or she does. 2. Ask the patient what hours he or she works. 3. Ask the patient if there are any risks involved in his or her work. 4. Document the health factor screening results using the associated health factor codes. More than one health factor can be documented for the patient.  Works under an administrator or other supervisor 
C009  BARRIERS TO LEARNING  F078  SPEAKS ENGLISH AS A SECOND LANGUAGE  Barriers to learning are patient specific. They usually are not visit specific, but rather relate to the patient's overall health status. Assess barriers by observation and interview, and then document them to alert other healthcare providers who may provide education. It is important to accommodate and overcome barriers to enhance patient learning. Assess barriers annually or any time the situation warrents assessment. 1. Observe and question the patient for any barriers to learning. a.Visually Impaired - The patient may divert the eyes, squint, or state his or her difficulty seeing. b.Blind - The patient may divert the eyes, wear sunglasses inside, state his or her inability to see, or is diagnosed with blindness (best corrected vision is =20/200 or =20 degrees of visual field in the better eye). c.Hard of Hearing - The patient may not respond to questions initially and may ask for things to be repeated, may speak loudly, bend ear or lean toward the speaker, or wear a hearing device. d. Deaf - The patient may not respond to questions, may look intently at your lips as you speak, may motion to communicate by writing, may use sign language to indicate deafness, or may have a diagnosis of deafness. e.Doesn't Read English - Ask the patient or the patient’s family about his or her ability to read English. The patient may be embarrassed to admit he or she cannot read English or may make excuses such as “I forgot my glasses.” This is a sensitive subject and must be treated accordingly. Stress “English” in this evaluation and acknowledge that the patient’s primary language may be unwritten. Another technique is to have the patient read a sentence that could be interpreted in different ways and ask the patient how he or she interprets the sentence. If the patient is unable, state that reading English can be hard for people who learned another language first and ask if this applies to him or her. f.Speaks English as a Second Language - The patient speaks English fluently, but may have minor barriers due to differences in primary language. g.Interpreter Needed - The patient may verbalize the need for an interpreter, answer questions inappropriately, or answer or nod “yes” to all questions. These actions could also imply hearing difficulty and may require further assessment. h.Fine Motor Skills Deficit - The patient may have difficulty or lack the physical control to direct or manage body movement, such as paralysis, arthritis, amputation, unable to handle testing supplies (for example checking blood sugars or measuring medications). i.Dementia - The patient may answer questions inappropriately, behave inappropriately, or display symptoms of confusion or forgetfulness. The patient may have a documented diagnosis of dementia. j.Values or Beliefs - The patient may comment or be asked about values or beliefs in relation to health information or medical or clinical aspects of health care. k.Stressors - The patient may appear distraught, avoid eye contact, or show anger. The emotional stressors may be acute or ongoing. e.g., personal issues (marital/relationship problems, unemployment/financial stress, lack of housing, problems with children/family members) or behavioral issues (mood, anxiety, grief). Emotional stressors are internal while social stressors are external. l.Low Health Literacy - Assessment is made by a low score on a health literacy screening tool or observation. m.Cognitive Impairment - The patient may be unable to give return demonstration, fails to understand simple information despite multiple attempts to teach, or has a diagnosis of cognitive impairment. n.Developmental Delay - (DO NOT USE) The patient may behave younger than actual age. o.Learning Disability - (DO NOT USE) The patient may comment about a learning disability or be diagnosed as such. p.Childhood Development - (DO NOT USE) The pediatric patient is of an age or cognition level that he or she relies on others for care. q.Less than 6th Grade Education - (DO NOT USE) Must assess by asking grade level completed. r.Social Stressors - (DO NOT USE) The patient may appear distraught, avoid eye contact, or show anger. The stressors may be acute or ongoing, as in the case of conflict, mental disorders, disease, death, alcohol or substance abuse, or domestic violence. Social stressors are external while emotional stressors are internal. 2. Document the health factor screening results using the associated health factor codes.  The patient’s primary language is not English. 
C012  CONFIDENCE IN MANAGING HEALTH PROBLEMS  F091  SOMEWHAT SURE  Use this health factor to assess the likeliness that the patient will take an active role in managing their health and well being. 1.Ask the patient, "How sure are you that you can manage and control most of your health problems." 2.Document the health factor screening results using the associated health factor codes.   The patient is at least 70% confident that they can take an active role and manage most of their health problems. The patient is likely to achieve their health goals. 
C011  ACTIVITY LEVEL  F086  SOME ACTIVITY  Use Activity level to document the average amount of physical activity in which the patient engages. 1. Ask the patient if he or she engages in physical activity. 2. Ask the patient in what activities he or she is engaged. 3. Ask the patient how much time he or she spends engaging in this activity. 4. Document the health factor screening results using the associated health factor codes.  For patients age 18 and over: Engages in < 150 minutes (approximately 30 minutes four or fewer times a week) of physical activity per week (For patients age 6-17: <210) 
C017  TOBACCO (SMOKING)  F111  SMOKING STATUS UNKNOWN  Use this health factor to document whether the patient smokes tobacco (cigarettes, pipe, or cigars) or has a history of smoking. 1. Ask the patient if he or she smokes tobacco or has smoked tobacco in the past (cigarettes, pipe, or cigars). 2. Ask the patient if he or she smokes tobacco products for cultural or religious purposes. 3. Document the Smoking Assessment factor screening results using the associated health factor codes.   Unable to assess the patient’s smoking status (patient may be unconscious or unresponsive). 
C015  TOBACCO (EXPOSURE)  F006  SMOKER IN HOME  Use this health factor to document whether the patient is exposed to tobacco smoke at home or work. 1. Ask the patient if he or she is exposed to tobacco smoke at work. 2. Ask the patient if anyone uses tobacco products at home. 3. ocument the health factor screening results using the associated health factor codes.   Is exposed to secondhand smoke at home. 
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