Social Needs Referral and Resource Tracking Log

Log to track referrals to community resources for identified social needs and follow-up outcomes.

Referral Record

• Referral Date
• Referral Source
• Primary Social Need
• If other, describe the social need
• Referral Priority
• Brief Case Notes
  Enter only the details needed to support the referral and follow-up. Avoid unnecessary PII.

Person and Consent

• Client Name
  Optional if your workflow allows anonymous or de-identified tracking.
• Client ID or Record Number
  Use an internal identifier instead of collecting full identifiers when possible.
• Preferred Contact Method
• Contact Information
  Provide only the contact detail needed for follow-up. Do not include sensitive identifiers unless necessary.
• Consent to Share Information with Community Resource
  Confirm that the person has consented to share the minimum necessary information with the referred resource.
• Track This Referral Anonymously
  Use this when the referral can be tracked without direct identifiers.

Resource Referral Details

• Community Resource Name
• Resource Category
• Referral Method
• Resource Contact Information
  Enter the contact details for the community resource, not the client.
• Eligibility or Access Notes
• Documents or Information Sent

Follow-Up and Outcome

• Current Referral Status
• Follow-Up Date
• Number of Contact Attempts
• Outcome Summary
  Summarize the outcome, barriers encountered, and next steps.
• Barriers to Access
• Next Step

Audit Trail

• Entered By
• Entry Timestamp
• Reviewed By
• Review Notes