HousingSubstance use supportMental health supportCaregiver supportTransportationInsurance/financialPlacementDV/safetyFood insecurityMedication accessEnd of lifeOther
Specify:
What SW Did
Resources providedCollateral obtained and documentedWarm handoff completedReferral submittedCoordinated with familyCoordinated with outpatient teamTransportation arrangedAPS/CPS report filedSafety planning completedPatient declined servicesOther
Engaged/cooperativeLimited engagementAgitatedUnable to assessSomnolent/intoxicatedFamily primarily engagedRepeatedly declines supportOther
Specify:
Known Barriers
No phoneNo transportationNo PCPUnhousedCognitive impairmentActive substance usePsychiatric instabilityInsurance barrierLimited support systemFrequent ED utilizationHealth literacy concernsOther