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If Yes,what system does your organization use? <br /> Fire Department uses ESO Solutions. <br /> Does your organization allow patients/clients access to their records/charts? ❑Yes ✓❑No <br /> Does your organization allow patients/clients access to narrative notes in their records/charts? <br /> ❑Yes ❑No <br /> What services does your organization currently provide to people on Medicaid?(select all that apply) <br /> [❑ Physical Health Services(Primary Care, Pediatrics, Inpatient Hospital services) <br /> Emergency Department or EMS Diversion Interventions <br /> ❑ Reproductive and Maternal Health Services <br /> O Behavioral Health Services(Mental Health or Substance Use services) <br /> El Substance Use Disorder Prevention,Overdose Prevention,Treatment and Recovery <br /> ❑ Inpatient Mental Health Hospital and Facility Transitional Care Services <br /> ❑ Dental Care and other Oral Health Services <br /> E] Food Security&Nutrition Services <br /> O Housing&Homelessness Services <br /> 0 Transportation Services . . <br /> ❑✓ Care Coordination with external services/organizations(beyond your own organization) <br /> ❑✓ Law Enforcement or Jail Diversion Interventions <br /> ❑ Jail and Incarceration Transition Services <br /> ❑ Pharmacy Services <br /> ❑ Community-based Chronic Disease Prevention&Management(i.e., diabetes, heart disease, asthma) <br /> Identify populations that your organization serves(check all that apply): <br /> ❑✓ Chronic and/or high system utilizers(medical,law enforcement and/or social services) <br /> El At-risk and/or experiencing homelessness <br /> ❑✓ Experiencing serious mental illness <br /> O At-risk and/or previously arrested and/or Incarcerated <br /> El At-risk,misusing,using and/or'abusing opioids <br /> ✓❑ At-risk and/or experiencing Adverse Childhood Experiences,Abuse and/or Trauma <br /> Q At-risk and/or experiencing co-occurring disorders/conditions(MI/SUD/Chronic Conditions) <br /> Q At risk and/or experiencing disparities in access and utilization of health services <br /> ❑ At risk and/or experiencing health outcome disparities <br /> ❑ Women(15-44 year)with high-risk or unintended pregnancy <br /> North Sound ACH May 2018 Call for Partners Application 3 <br />