Street Medicine Notes Street Medicine Care Coordination Note Your NameEugeneAnushkaAngelWilliamYour LCEugeneWilliamPatient's Full NamePatient's DOBPronounsShe/herHe/HimThey/ThemOtherSmoking statusDoes not smokeYesQuitVapesDid not askHow many packs per day and how many years?Patient's reported allergies:Does the patient have health insurance and/or FAP?Does the patient have a cellphone?YesNoDid not askPatient's Cellphone NumberIf we needed to find this patient to f/u on anything, where do they generally stay and/or how could we reach them?What medications do they take?How do they get their medications?They do not take medicationsGRACE PharmacyRetail PharmacyDispensed from Street Medicine/MOC StockPAPDid not askIntroduce & Offer Care Coordination?Yes - pt not interestedYes - pt interestedYes - patient has a care coordinatorNoSDOH Screening Completed?YesNoPatient's SDOH Priority AreasResources provided during street medicine visitFree Space for Additional Notes
