0915-0338_MCHB_HSMED_Implementation Guide Demographic Form_Redline_03052025

Grantees of the Health Resources and Services Administration’s (HRSA) Healthy Start program are required to collect and report client-level data as a condition of their 2024-2029 grant awards. On May 1, 2024, the Division of Healthy Start and Perinatal Services (DHSPS) released four OMB-approved Healthy Start Data Collection Forms (Demographic, Background, Prenatal, and Parent/Child forms) to begin generating these required data. The Healthy Start Data Collection Forms are client-level surveys that gather information on the characteristics of program participants, including individuals who attend group-based health education classes, and those who are enrolled in case management/care coordination services. The latest versions of the Healthy Start Data Collection Forms can be accessed on the Healthy Start EPIC website at https://www.healthystartepic.org/healthy-start-implementation/data_collection_forms/.

On July 1, 2024, grantees will begin reporting their collected client-level data to HRSA through the Healthy Start Monitoring and Evaluation Data System (HSMED). The HSMED is integrated with HRSA’s Electronic Handbooks (EHBs) and is accessible using the EHBs’ login portal. The first submission of client-level data will be due on July 16, 2024, and continue each quarter thereafter. Healthy Start grantees are required to submit client-level data files by the third Tuesday of each quarterly reporting month.

To successfully complete quarterly submissions, each grantee must create and upload Extensible Markup Language (XML) or Comma Separated Values (CSV) files containing client-level data collected during the three months prior to submission (“reporting quarter”). The structure, sequence, values, and format of the data elements in the client-level data files must conform to the definitions specified in the XML/CSV reference materials. When client-level data files are uploaded to the system, the HSMED will validate the files to ensure they conform to the data schema and business rules outlined in the XML/CSV reference materials before grantees can finalize their submissions. The latest versions of the XML/CSV reference materials can be accessed on the Healthy Start EPIC website at https://www.healthystartepic.org/healthy-start-implementation/monitoring-data-and-evaluation/. An HSMED User Manual can also be found at the same link to assist grantees in navigating the system, and completing quarterly data submissions.

NOTE: This document does not contain instructions on how to upload the client-level data XML files to the HSMED application. Instructions on using the HSMED are available in the HSMED User Manual.

Purpose

The purpose of this document is to provide reference information on the definition, allowable structure, sequence, values, and format of the Healthy Start client-level data XML and CSV files to grantees, providers and software vendors. This document includes data definitions that describe the meaning of each element in the Healthy Start client-level data. In addition, this document describes the required format of the XML file, provides examples of XML files, and includes references to the XML schema definitions that are used to validate the XML file. Ultimately, the goal of this document is to help grantees reduce any errors that may result when they generate and submit client-level data XML files to the HSMED.

Audience

This document is intended for Healthy Start technical and/or administrative staff that must collect and report Healthy Start client-level data elements in an XML or CSV file format to the HRSA/MCHB Healthy Start program. Such staff may include developers, data quality specialists, administrators, or other individuals who are responsible for generating and submitting the quarterly reports.

Updates

This document will be revised as variables and value options are updated or when other global changes are made.

Version	Date	Comments
V1.0	November 19,2020	First version of Implementation guide for the HSMED system.
V1.1	January 28, 2021	Updates and corrections for a few data elements.
V2.0	February 10, 2022	Upgrades and revisions to the data validation types and messages for the Background, Prenatal and Parent/Child forms.
V3.0	May 23, 2024	Upgrades and revisions to the data validation types and messages for the Background, Prenatal and Parent/Child forms. Addition of data validation types and messages of the new Demographic form.
V4.0	Feb 27, 2025	Introduce the Year of Birth and a Year of Death data elements on the Prenatal Form and the Parent/Child Form. Update to the Transportation element in the Background form to accept multiple responses.

Summary of Changes: March 3, 2025

Demographic Form:

In compliance with Executive Order 14168, the following data elements were removed from the Demographic form: Gender and OtherGenderSpecification.

Prenatal Form:

The following new data elements are added in the Prenatal form: BirthYear and NeonatalDeathYear.

The following data elements have been upgraded to flag Errors: BirthYear, NeonatalDeathYear, NeonatalDeath, NeonatalDeathNumber and PregnancyEndDate.

The following data elements have been upgraded to flag Warnings: BirthYear, DeathYear and NeonatalDeath.

Parent/Child Form:

In compliance with Executive Order 14168, the following data element was removed from the Parent/Child form: ChildGender; this data element was replaced with ChildSex.

The following new data elements are added in the Parent/Child form: ChildBirthYear and ChildDeathYear.

The following data elements have been upgraded to flag Errors: ChildBirthYear and ChildDeathYear.

The following data elements have been upgraded to Required fields: ChildBirthYear.

Summary of Changes: May 23, 2024

Demographic Form:

The following new data elements are added in the Demographic form: PPUID, ParticipantType, OtherAdultRelationship, FormVersion, CompletionDate, UpdateDate, Correction, PPEnrollmentPhase, ParticipantAgeAtEnrollment, ParticipantAgeAtEnrollmentDD, ~~Gender,~~ ~~OtherGenderSpecification~~, Sex, HispanicLatino, RaceMulti, OtherLanguage, OtherLanguageSpecification, EnglishFluency and HighestLevelSchool.

The following data elements have been upgraded to flag Errors: PPUID, FormVersion, CompletionDate, UpdateDate, PPEnrollmentPhase, ParticipantAgeAtEnrollment, ParticipantAgeAtEnrollmentDD, HispanicLatino, RaceMulti and OtherLanguageSpecification.

The following data elements have been upgraded to flag Warnings. For each of these fields, a warning comment field is also introduced to enable grantees to provide a justification comment in cases where the warnings cannot be resolved: CompletionDate.

The following data elements have been upgraded to Required fields: PPUID, ParticipantType, FormVersion, CompletionDate, PPEnrollmentPhase, ~~Gender~~, Sex, HispanicLatino, RaceMulti, OtherLanguage, EnglishFluency and HighestLevelSchool.

Background Form:

The following existing data elements of the Background form are deleted: ParticipantType, OtherPPSpecification,HasEnrolledChild, PPEnrollmentPhase, AgeClassification, Sex, ~~NonBinaryGender~~, HighestLevelSchool, HispanicLatino, RaceMulti, RaceSingle, OtherRaceSpecification, HasUsualHealthcareSource, UsualHealthcarePlace, OtherHealthcarePlaceSpecification, DependentsOnIncomeNumber, DependentsOnIncomeDD, CurrentChildrenEnrolled, ChildrenEnrolledNumber, ScreenedForDepression, IPVScreenerAdministered, MarijuanaUse, IPVScreenerNotAdministeredSpecification, TotalChildrenDesired, TotalChildrenDesiredDD, PlannedMonthsToNextPregnancyDD, OtherRPLSpecification, HasRLP, ExitSpecification.

The following new data elements are added in the Background form: FormVersion, NoPPEnrollmentDate, UpdateType, Correction, ParentingStatus, CurrentlyParentingChildrenNumber, HouseholdIncomeAmount, FoodSecurity, HadAdequateHousing, HousingSafety, Transportation, CannabisProductUse, ReferredForTobaccoUse, ReferredForIPV, SingletonBirthNumber, MultiplesLBWBabiesNumber, PreviousChildDeathNumberDD and PreviousChildDeathAgeDD.

The following data elements have been upgraded to flag Errors: NoOtherPP, PPEnrollmentDate, No PPEnrollmentDate, FormVersion, UpdateType, CompletionDate, EndsPrenatalDate, ECTurns6MonthsDate, OtherUpdateDate, ExitDate, PregnancyStatus, ParentingStatus, CurrentlyParentingChildrenNumber, InsuranceType, MedicaidNameSpecification, OtherInsuranceSpecification, HouseholdIncomeAmount, AdultsDependentOnIncomeNumber, ChildrenDependentOnIncomeNumber, LittleInterestScore, FeelDownScore, DepressionTotal, ReferredForDepression, ReferredForTobaccoUse, WasThreatened, WasFrightened, WasControlled, WasPhysicallyHurt, WasForced, MoreChildrenDesired, PlannedMonthsToNextPregnancy, UsingCondom, BirthControlUsed, PregnancyHistory, LiveBirthNumber, SingletonBirthNumber, HadPreviousPretermBirth, PretermDeliveriesNumber, HadLbw, LBWBabiesNumber, MultiplesLBWBabiesNumber, VeryLBWBabiesNumber, HadMacrosomia, FetalMacrosomiaNumber, PreviousInfantDeath, PreviousChildDeathNumberDD, PreviousNeonatalDeathNumber, PreviousChildDeathAgeDD.

The following data elements have been upgraded to Required fields: PPUID, FormVersion, CompletionDate, PregnancyStatus, ParentingStatus, HadPreventiveCare, HadHealthcare, InsuranceType, HouseholdIncome, FoodSecurity, HadAdequateHousing, HousingSafety, Transportation, LittleInterestScore, FeelDownScore, ReferredForDepression, TobaccoUse, AlcoholUse, CannabisProductUse, IllicitDrugUse, PrescriptionMedsUse, ReferredForTobaccoUse, WasThreatened, WasFrightened, WasControlled, WasPhysicallyHurt, WasForced and ReferredForIPV.

Prenatal Form:

The following existing data elements of the Prenatal form are deleted: OtherLinkedPP, NoOtherPP, PPEnrollmentDate, OtherUpdateSpecification, WeeksPregnantUnableToDetermine, WeeksPregnantUnableToDetermineSpecification, NoFirstPrenatal, FirstPrenatalTrimester,

CurrentPregnancyTrimester, InterconceptionInterval, FatherInvolvement, CurrentCigarettesPerDay, CurrentECigaretteFrequency, CurrentHookahFrequency, EnrolledPregnancyTrimester, CurrentChewingTobaccoFrequency, CurrentCigarFrequency, FetusesNumber FirstPrenatalMonthsNumber, CurrentAlcoholFrequency, PostPregnancyFuDate, PPUIDConfirmation, TrackOutcomeMethodSpecification, NeonatalDeathMethodSpecification, MaternalDeathMethodSpecification.

The following new data elements are added in the Prenatal form: FormVersion, NewPregnancyDate, Correction, EnrolledPregnancyWeeks, FirstPrenatalWeeksNumber, BabiesNumber, HadHIV, HadSTI, HadObesity, HadChronicHeartDisease, OtherChronicConditions, DiagnosedWithGestationalDiabetes, DiagnosedWithBloodPressure, PreEclampsia, HIVAIDS, DiagnosedWithSTI, MaternalMorbidity, MaternalMorbiditySpecification and DeliveryType.

The following data elements have been upgraded to flag Errors: FormVersion, UpdateType, NewPregnancyDate, CompletionDate, PregnancyEndsDate, OtherUpdateDate, DueDate, FirstPrenatalAppointmentScheduled, FirstPrenatalAppointmentDate, OtherChronicConditionsSpecification, FetalDeathsNumber, MaternalMorbidity, MaternalMorbiditySpecification, DeliveryType, EnrolledChildID, NeonatalDeathNumber, MaternalDeath and PregnancyOutcomesOtherSourceSpecification.

The following data elements have been upgraded to Required fields: PPUID, FormVersion, CompletionDate, WeeksPregnantNumber, EnrolledPregnancyWeeks, FirstPrenatalWeeksNumber, PregnantWithMultiples, HadDiabetes, HadHighBloodPressure, HadDepression, HadHIV, HadSTI, HadObesity, HadChronicHeartDisease, OtherChronicConditions, DiagnosedWithGestationalDiabetes, DiagnosedWithBloodPressure, PreEclampsia, HIVAIDS, DiagnosedWithSTI and BreastfeedingPlans.

Parent/ Child Form:

The following existing data elements of the Parent/Child form are deleted: ParticipantType, OtherPPSpecification,PPEnrollmentDate, OtherUpdateSpecification, ExitSpecification, ChildAgeRange,ChildRaceSingle, OtherRaceSpecification,PretermBirth, LBW, ChildHasUsualHealthcareSource,ChildUsualHealthcarePlace, ChildOtherHealthcarePlaceSpecification,ReadWithChild, FatherInvolvementWithChild, Last3MonthsCigarettesPerDay, Last3MonthsHookahFrequency, Last3MonthsChewingTobaccoFrequency and Last3MonthsCigarFrequency.

The following new data elements are added in the Parent/Child form: FormVersion, Correction, 12MonthDate, HadInfantHospitalStay, ChildAgeRange, ChildAgeMonths, AgeWellVisitMonths, Last3MonthsTobaccoFrequency.

The following data elements have been upgraded to flag Errors: NoOtherPP, ChildEnrollmentDate, FormVersion, CompletionDate, UpdateType, 6MonthDate, 12MonthDate, ChildExitDate, AgeAtEnrollment, ChildEthnicity, ChildRace, ChildAgeMonths, ChildInsuranceType, ChildMedicaidNameSpecification, ChildOtherInsuranceSpecification, AgeWellVisitMonths, BreastfedMonths, ReceivedPostpartumCare and Last3MonthsTobaccoFrequency.

The following data elements have been upgraded to Required fields: FormVersion, CompletionDate, HadInfantHospitalStay, ChildAgeRange, ChildHadHealthcare, ChildInsuranceType, AgeWellVisit, BreastfedEver, BreastfedCurrently, HowLongBreastfed, BabySleepPosition, BabySleepsAlone and SafeSleepBedding.

Main Components of the Client-Level XML File

The Healthy Start client-level data XML file consists of three components: 1) the file header, 2) the root element, and 3) the body elements, which consist of complex and simple data elements.

File Header

The file header is the first line of text in the XML file. It is static text and does not change, and it contains the XML declaration—the version of XML—and encoding being used. A sample file header is shown below:

<?xml version=”1.0” encoding=”UTF-8”?>

Root Element

The root element consists of static text and does not change. A root element is required for every XML file, and it serves as “the parent” of all the other elements. In the case of the Healthy Start client-level data XML file, the root element is <ROOT xmlns=”urn:hsmd”>.

Body: Simple and Complex Elements

The body of the client-level data XML file contains all the elements under the root element. It contains simple and complex elements. Complex elements contain child elements (e.g., lists) and usually allow more than one child element. Simple elements do not contain any child elements. An example of a complex element that contains two child elements is below:

<OtherLinkedPP>100String123345</OtherLinkedPP>

<OtherLinkedPP>100String78900</OtherLinkedPP>

</OtherLinkedPPList>

Healthy Start Client-Level Data XML Data Elements

This section includes definitions for all the data elements (both complex and simple) in the body of the Healthy Start client-level data XML file. The definitions are presented in tables, and each table includes one or more of the following metadata:

Element Name: The descriptive and brief name of the variable to provide information about what is being collected. This corresponds to the data element name in the Healthy Start Client-Level Data XML Schema.

Question Number: The question number in the Healthy Start Data Collection Forms.

Section & Sub-section: Data elements are grouped in sections and sub-sections corresponding to the Data Collection Form. Each section and sub-section is a complex list data element, and the section tags are required in the XML files. The sections and sub-sections are required components in the XML files, and elements must be included in the correct section to allow successful uploads.

Definitions: A brief description of the variable.

Required field: Whether an element is required to submit the XML file. If a required field is missing, the XML file will be rejected.

Allowed Values: The type or list of values allowed for the data element. If the acceptable values are codes, the meaning of each code is also provided. Note HSMED requires users to submit numeric codes in lists of values (e.g., if the value and description are “1 – Yes,” then 1 should be submitted instead of “Yes”). For Boolean fields, the field accepts only 1 or 0.

Allow multiple values: Whether the variable accepts multiple values. It corresponds to “choose-all-that-apply” questions in the Data Collection Forms. Normally only complex elements can accept multiple values. These element names have “List” as a suffix. The XML sample for list elements shows how multiple values are presented in the XML file.

Occurrence: The minimum and maximum number of times the element may appear in a single record within the client-level data XML file. For required elements, the minimal occurrence is 1.

XML example: Sample XML that indicates the use of the element within the context of the client-level data XML file.

Data validation type: Whether the element has a data validation check, and if so, the type of data validation. If an element has no data validation check, it will be “none.” There are three types of data validation checks:

Errors: All errors must be resolved before the report can be successfully accepted.
Warnings: Users must review and, if appropriate, resolve their warnings. Users must enter a justification comment in the CSV or XML file, and re-upload it to the system to submit the report and resolve the warning(s).
Alerts: A report can be submitted with alerts. Users do not need to enter comments to explain the data that caused the alert.

Data validation rule: The logic of data validation check and the corresponding error messages.

Instructions for Preparing CSV Files

The CSV files follow the same data element specifications and are subject to the same validation checks outlined in the Implementation Guides. There are a few special instructions for preparing the CSV files.

Column Names

The column names in CSV follow the naming convention: form_section_sub-section(s)_data element name. Examples are below:

In the Demographic Form, the column names look like: HsmedDemographic_CoverPage_ParticipantType, or HsmedDemographic_ClientInfo_ParticipantGeneralInfo_ParticipantAgeAtEnrollment

In the Background Form, the column names look like: HsmedBackground_CoverPage_FormVersion, or HsmedBackground_ClientInfo_PersonalWellBeing_LittleInterestScore

In the Prenatal Form, the column names look like: HsmedPrenatal_CoverPage_PregnancyEndsDate, or HsmedPrenatal_ClientInfo_PregnancyAndHealth_EnrolledPregnancyWeeks

In the Parent/Child Form, the column names look like: HsmedParentChild_CoverPage_CompletionDate, or HsmedParentChild_ClientInfo_InfantHealthCare_ChildHadHealthcare

NOTE: The column names and order must be the same as the template for the file to be accepted. If there is no information for an element, the “cell” should be left empty, but the column must remain in the file.

Multiple Values

If one data element allows multiple values, all of the values should be included in one “cell” and separated by a pipe symbol “|” (found on most keyboards using SHIFT + \ ). Users should not enter spaces between the data values and the pipe symbol. For example, if there are two other linked primary participants reported in the Background Form, it should be listed as “100PP12345|100PP23456” in column “HsmedBackground_CoverPage_OtherLinkedPPList_OtherLinkedPP”.

NOTE: If a data element does not allow multiple values (e.g., elements that allow a text string), the pipe symbol will not be recognized as a delimiter for different values. For example, value “text string 1 | text string 2” for a single-value element will be read as one text string.

Data Elements in the Demographic Form

Element name: PPUID

Field	Description
Question Number	Cover page 1 (G1)
Section & Sub-section	CoverPage
Definition	Primary participant unique ID
Required field	Yes (May not have duplicates of Unique IDs in one file during upload checking)
Allowed values	Alphanumeric text string that allows a minimum of 9 characters and a maximum of 50 characters. PPUIDs should be in the format: 3 digit grantee org code + PP + a unique ID (at least 4 digits long). NOTE: With the exception of the initial ‘PP’ format requirement, PPUIDs are NOT case-sensitive (for example, 123PPUID0001 and 123Ppuid0001 would be considered the same client).
Allow multiple values	No
Occurrence	1 unique value per client
XML example	<PPUID>100PP12345</PPUID>
Data Validation Type	Error Error
Data Validation Rule	[If there are two or more of the same PPUID] – The PPUID '({PPUID)' is duplicate. [If Org ID in PPUID does not match the Organization] – The PPUID has an invalid Org ID.

Element name: ParticipantType

Field	Description
Question Number	Cover page 2 (G2)
Section & Sub-section	CoverPage
Definition	Participant type
Required field	Yes
Allowed values	1 - CM/CC participant 2 - Group-based health education participant 3 - Other adult
Allow multiple values	No
Occurrence	1 per client
XML example	<ParticipantType>1</ParticipantType>
Data Validation Type	None
Data Validation Rule	None

Element name: OtherAdultRelationship

Field	Description
Question Number	Cover page 2 (G2)
Section & Sub-section	CoverPage
Definition	Other Adult relationship to enrolled child
Required field	No
Allowed values	1 - Grandparent 2 - Family member 3 - Foster parent 4 - Other legal guardian
Allow multiple values	No
Occurrence	0-1 per client
XML example	< OtherAdultRelationship>1< OtherAdultRelationship>
Data Validation Type	None
Data Validation Rule	None

Element name: FormVersion

Field	Description
Question Number	Cover page 3 (G3)
Section & Sub-section	CoverPage
Definition	Version (initial or update) of the form
Required field	Yes
Allowed values	1 – Initial form 2 – Updated form
Allow multiple values	No
Occurrence	1 per client
XML example	<FormVersion>1<FormVersion>
Data Validation Type	Error Error
Data Validation Rule	[If an Initial Form for this PPUID already exists, FormVersion selected as Initial Form and correction checkbox not checked] – If this is an update to the Demographic Form, 'FormVersion' should be provided as 'Updated Form'. If this is a correction, please check 'This form is a correction'. [If an Initial Form does not exist and user is selecting "Updated Form" in FormVersion] – If this is an initial upload to the Demographic Form, FormVersion should be provided as ‘Initial Form’.

Element name: CompletionDate

Field	Description
Question Number	Cover page 3 (G3)
Section & Sub-section	CoverPage
Definition	Date of initial form completion
Required field	Yes
Allowed values	Date with a format of mm/dd/yyyy The dates can only be entered between 04/30/2024 and the date of upload into the HSMED system.
Allow multiple values	No
Occurrence	0-1 per client
XML example	<CompletionDate>9/10/2024</CompletionDate>
Data Validation Type	Warning Error
Data Validation Rule	[If different from previous submission and correction checkbox is not checked] – The 'CompletionDate' is different than previously reported. Please confirm the date of initial completion or explain the reason for the change. Note: If completion date is different than the previously submitted value in the system and correction checkbox is checked, then validation will not appear. [If date falls outside of valid range, ‘CompletionDate’ is not in a valid range] – The 'CompletionDate' is not in the valid range. Please refer to the HS Implementation Guide.

Element name: UpdateDate

Field	Description
Question Number	Cover page 3 (G3)
Section & Sub-section	CoverPage
Definition	Date of form update
Required field	No
Allowed values	Date with a format of mm/dd/yyyy The dates can only be entered between 04/30/2024 and the date of upload into the HSMED system.
Allow multiple values	No
Occurrence	0-1 per client
XML example	<UpdateDate>9/10/2024</UpdateDate>
Data Validation Type	Error Error
Data Validation Rule	[If date falls outside of valid range, ‘UpdateDate’ is not in a valid range] – The 'UpdateDate' is not in the valid range. Please refer to the HS Implementation Guide. [If Updated form (2) is selected in ‘FormVersion’ but ‘UpdateDate’ is blank] – Element 'UpdateDate' is required when FormVersion is selected as ‘Updated Form’.

Element name: Correction

Field	Description
Question Number	Cover page 4
Section & Sub-section	CoverPage
Definition	Correction box
Required field	No
Allowed values	0 - No 1 - Yes
Allow multiple values	No
Occurrence	0-1 per client
XML example	<Correction>1</Correction>
Data Validation Type	None
Data Validation Rule	None

Element name: CompletionDateWarningComment

Field	Description
Question Number	NA
Section & Sub-section	CoverPage
Definition	Warning justification if CompletionDate value is different than previously reported
Required field	No
Allowed values	Text string that allows a maximum of 250 characters
Allow multiple values	No
Occurrence	0-1 per client
XML example	< CompletionDateWarningComment>String</ CompletionDate WarningComment>
Data Validation Type	Warning
Data Validation Rule	See element CompletionDate

Element name: PPEnrollmentPhase

Field	Description
Question Number	1
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Participant reproductive phase at enrollment
Required field	Yes
Allowed values	1 - Preconceptive 2 - Pregnant or expecting 3 - Postpartum 4 - Parenting an infant less than 6 months of age 5 - Parenting a child 6-11 months of age 6 - Parenting a child 12-18 months of age 77 - None of the above 88 - Declined to answer
Allow multiple values	Yes
Occurrence	1-6 per client
XML example	<PPEnrollmentPhaseList> <PPEnrollmentPhase>1</PPEnrollmentPhase> <PPEnrollmentPhase>3</PPEnrollmentPhase> </PPEnrollmentPhaseList>
Data Validation Type	Error Error
Data Validation Rule	[If different from initial submission] – The 'PPEnrollmentPhase' is different than previously reported. Please confirm the participant’s reproductive phase at enrollment or explain the reason for the change. [If “None of the above" or "Declined to answer" is checked and 1 or 2 or 3 or 4 or 5 or 6 are also selected ] – If "None of the above" or "Declined to answer" is selected, de-select any other 'PPEnrollmentPhase' selected.

Element name: ParticipantAgeAtEnrollment

Field	Description
Question Number	2
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Participant age at enrollment
Required field	No
Allowed values	An integer value between 1-99
Allow multiple values	No
Occurrence	1-0 per client
XML example	< ParticipantAgeAtEnrollment >16</ ParticipantAgeAtEnrollment >
Data Validation Type	Error
Data Validation Rule	[If ‘ParticipantAgeAtEnrollment’ and ‘ParticipantAgeAtEnrollmentDD’ are blank] – Input 'ParticipantAgeAtEnrollment' or select “Declined to answer.”

Element name: ParticipantAgeAtEnrollmentDD

Field	Description
Question Number	2
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Participant age at enrollment declined
Required field	No
Allowed values	88 - Declined to answer
Allow multiple values	Yes
Occurrence	1-8 per client
XML example	< ParticipantAgeAtEnrollmentDD >88</ ParticipantAgeAtEnrollmentDD>
Data Validation Type	Error
Data Validation Rule	[If ‘ParticipantAgeAtEnrollment’ and ‘ParticipantAgeAtEnrollmentDD’ are blank] – Input 'ParticipantAgeAtEnrollment' or select “Declined to answer.”

Element name: Sex

Field	Description
Question Number	4
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Sex of person being interviewed
Required field	Yes
Allowed values	1 - Female 2 - Male 88 - Declined to answer
Allow multiple values	No
Occurrence	1 per client
XML example	<Sex>1</Sex>
Data Validation Type	None
Data Validation Rule	None

Element name: HispanicLatino

Field	Description
Question Number	5
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Hispanic ethnicity
Required field	Yes
Allowed values	1 - No, not of Hispanic, Latino/a, or Spanish origin 2 -Yes, Mexican, Mexican American, Chicano/a 3 - Yes, Puerto Rican 4 - Yes, Cuban 5 - Yes, Another Hispanic, Latino/a, or Spanish origin 88 - Declined to answer
Allow multiple values	Yes
Occurrence	1-4 per client
XML example	<HispanicLatinoList> <HispanicLatino>3</HispanicLatino> <HispanicLatino>4</HispanicLatino> </HispanicLatinoList>
Data Validation Type	Error Error
Data Validation Rule	[If "No, not of Hispanic, Latino/a, or Spanish origin" is checked, no other selections are allowed] – If 'No, not of Hispanic, Latino/a, or Spanish origin' is selected, deselect any other options for 'HispanicLatino' [If "Declined to answer" is checked, no other selections are allowed] – If ‘Declined to answer’ is selected, deselect any other options for ‘HispanicLatino'.

Element name: RaceMulti

Field	Description
Question Number	6
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Race
Required field	Yes
Allowed values	1 - White 2 - Black or African American 3 - American Indian or Alaska Native 4 - Asian Indian 5 - Chinese 6 - Filipino 7 - Japanese 8 - Korean 9 - Vietnamese 10 - Other Asian 11 - Native Hawaiian 12 - Guamanian or Chamorro 13 - Samoan 14 - Other Pacific Islander 88 - Declined to answer
Allow multiple values	Yes
Occurrence	1-14 per client
XML example	<RaceMultiList> <RaceMulti>11</RaceMulti> <RaceMulti>12</RaceMulti> <RaceMulti>13</RaceMulti> </RaceMultiList>
Data Validation Type	Error
Data Validation Rule	[If "Declined to answer" is checked, no other selections are allowed] – If 'Declined to answer' is selected, deselect any other options for 'RaceMulti'.

Element name: OtherLanguage

Field	Description
Question Number	7
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Other language spoken at home
Required field	Yes
Allowed values	1 - Yes 0 - No 88 - Declined to answer
Allow multiple values	No
Occurrence	1 per client
XML example	<OtherLanguage>1</OtherLanguage>
Data Validation Type	None
Data Validation Rule	None

Element name: OtherLanguageSpecification

Field	Description
Question Number	7
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Other Language Specification
Required field	No
Allowed values	Text string that allows a maximum of 250 characters
Allow multiple values	No
Occurrence	1 per client
XML example	<OtherLanguageSpecification>String</OtherLanguageSpecification>
Data Validation Type	Error
Data Validation Rule	[If ‘OtherLanguage’ is selected as “Yes” and ‘OtherLanguageSpecification’ is empty] – Input a short text response for ‘OtherLanguageSpecification’.

Element name: EnglishFluency

Field	Description
Question Number	8
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	English fluency
Required field	Yes
Allowed values	1 - Very well 2 - Well 3 - Not well 4 - Not at all 88 - Declined to answer
Allow multiple values	No
Occurrence	1 per client
XML example	< EnglishFluency >1</ EnglishFluency >
Data Validation Type	None
Data Validation Rule	None

Element name: HighestLevelSchool

Field	Description
Question Number	9
Section & Sub-section	ClientInfo ParticipantGeneralInfo
Definition	Education
Required field	Yes
Allowed values	1 - No formal schooling 2 - 8th grade or less 3 - Some high school 4 - High school diploma 5 - GED 6 - Some college or 2 year degree 7 - Technical or trade school 8 - Bachelor's Degree 9 - Graduate or professional school 88 - Declined to answer
Allow multiple values	No
Occurrence	1 per client
XML example	<HighestLevelSchool>1</HighestLevelSchool>
Data Validation Type	None
Data Validation Rule	None

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Implementation Guide 1 Demographic
Author	Echo Wang;HRSA
File Created	2025:05:19 11:23:44Z

0915-0338_MCHB_HSMED_Implementation Guide Demographic Form_Redline_03052025