Street Medicine Notes Street Medicine Care Coordination Note Your NameDavidLaurenNicoleTylerClaudiaYour LCDavidLaurenNicolePatient's Full Name Patient's DOB PronounsShe/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 Number If 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