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Run: Social Needs Referral and Resource Tracking Log

Track social needs referrals, consent, follow-up attempts, and outcomes in one log. Use it to document what was referred, what was shared, and what happened ...

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Referral Record

Referral Date (required)

Referral Source (required)

Primary Social Need (required)

If other, describe the social need

Referral Priority (required)

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.

Yes No N/A

Track This Referral Anonymously

Use this when the referral can be tracked without direct identifiers.

Yes No N/A

Resource Referral Details

Community Resource Name (required)

Resource Category (required)

Referral Method (required)

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 (required)

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 (required)

Entry Timestamp (required)

Reviewed By

Review Notes

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Email (required)

Your name (optional)

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