Community Resource Referral Log

Track referrals to housing, employment, and support services, including consent, follow-up status, and wraparound care coordination outcomes.

Referral Record

• Referral Date
• Referral Source
• Primary Reason for Referral
  Select all that apply. Collect only what is needed for care coordination.
• Referral Summary
  Briefly describe the need and any relevant context. Avoid unnecessary PII.

Person and Consent

• Person's Name
  Optional if your workflow allows anonymous submission or uses an internal identifier instead of a name.
• Internal Client or Case ID
  Use an internal ID instead of collecting extra PII when possible.
• Preferred Contact Method
• Consent to Share Referral Information
  Required before sharing any PII with an external resource provider.
• Consent Notes
  Document any limits on consent, disclosures provided, or preferred communication boundaries.

Resource Referral Details

• Resource Category
• Resource or Provider Name
• Referral Method
• Scheduled Appointment Date
• Resource Contact Information
  Optional. Include only if needed for follow-up coordination.

Follow-Up and Outcome

• Is Follow-Up Needed?
• Follow-Up Due Date
• Current Follow-Up Status
• Outcome Notes
  Document outreach attempts, barriers, and next steps without unnecessary PII.
• Number of Outreach Attempts

Status, Escalation, and Audit Trail

• Referral Status
• Escalation Needed?
• Escalation Reason
• Audit Trail Notes
  Record key actions, dates, and handoffs for the referral history.