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Run: Limited English Proficiency Interpreter Use Log

Track each interpreter use instance with language, modality, qualification status, and follow-up notes so direct-service teams can monitor language access an...

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Encounter and Submission Details

Encounter Date (required)

Date the interpreter was used or requested.

Program or Service Area (required)

Name of the direct-service program where language access was provided.

Service Setting (required)

Where the encounter took place.

Submitted By (required)

Name of the staff member completing this log entry.

Submitter Role

Staff role or title of the person completing the log.

Language Access Need

Preferred Language (required)

Language requested by the client or identified by staff.

How Was the Language Identified? (required)

How staff determined the language need.

Was an Interpreter Requested? (required)

Indicate whether interpreter support was requested for the encounter.

Who Requested the Interpreter?

Shown when an interpreter was requested.

Was There a Language Access Barrier? (required)

Indicate whether communication was delayed or limited due to language access.

Interpreter Modality and Qualification

Was an Interpreter Used? (required)

Select yes if any interpreter support was used during the encounter.

Interpreter Modality

Shown when an interpreter was used.

Interpreter Type

Shown when an interpreter was used.

Qualified Interpreter Used?

Indicate whether the interpreter met your program's qualified-interpreter standard.

Interpreter Name or ID

Optional internal identifier for the interpreter. Avoid collecting unnecessary personal data.

Outcome and Follow-Up

Was Communication Successfully Completed? (required)

Indicate whether the encounter could proceed with adequate understanding.

Follow-Up Needed? (required)

Select yes if additional language access support is needed.

Follow-Up Action

Shown when follow-up is needed. Select all that apply.

Notes

Add brief, factual notes only. Do not include unnecessary PII or sensitive details.

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