SW Coordination Note

Initial contact Follow-up Crisis intervention Discharge coordination Placement coordination Resource linkage APS/CPS reporting Other

Housing Substance use support Mental health support Caregiver support Transportation Insurance/financial Placement DV/safety Food insecurity Medication access End of life Other

Resources provided Warm handoff completed Referral submitted Collateral obtained Coordinated with family Coordinated with outpatient team Transportation arranged APS/CPS filed Safety planning completed Patient declined services Other

Engaged/cooperative Limited engagement Agitated Unable to assess Somnolent/intoxicated Family primarily engaged Repeatedly declines support

No phone No transportation No PCP Unhoused Cognitive impairment Active substance use Psychiatric instability Insurance barrier Limited support system Frequent ED utilization Health literacy concerns Other

ECM BH case management Conservator Home health Hospice IHSS Family involved Shelter/navigation center SNF/LTC resident None known

Cleared from SW perspective Ongoing SW needs Unsafe discharge concern Placement pending Awaiting psych placement Awaiting medical clearance High readmission/utilization risk