Referral Intake | AfterNest

Patient & eligibility

Collect only the contact and practical information needed for this demonstration.

Patient first name or demo alias

Last initial

Age range

Preferred language

Phone

Preferred contact

Living situation

Caregiver availability

Referring role / team

Practical barriers

Select the non-clinical issues the patient would like help navigating after discharge.

TransportationRide planning, pickup logistics, accessible options, or travel coordination.TechnologyPortal access, video visits, digital scheduling, device basics, or non-app alternatives.Language navigationNon-clinical support in the patient’s preferred language. Medical interpretation remains with qualified health-system services.Caregiver coordinationAvailability, family communication, and practical support planning.Food & basic needsCommunity-resource connection for meals, groceries, or household basics.Appointment logisticsDate, time, location, directions, transportation, and non-clinical preparation.Resource follow-throughHelp contacting an approved service and confirming the next practical step.Staying organizedKeep a practical to-do list and prepare questions to bring back to the healthcare team.

Other non-clinical support need

Consent & boundaries

A production version would use partner-approved legal and consent language. This academic prototype demonstrates the intended workflow only.

Data minimization: AfterNest is designed so a Navigator generally does not need unrestricted access to diagnoses, medication lists, clinical notes, or the full medical record to support practical recovery tasks.

Voluntary participationThe patient chooses to participate in this non-clinical support program and can stop participating.Contact consentThe patient agrees that AfterNest may contact them using the preference provided in this demo referral.Scope acknowledgmentAfterNest does not provide medical advice. Clinical questions, symptoms, medication issues, treatment questions, or urgent concerns must be directed to the appropriate healthcare team or emergency service.Prototype acknowledgmentThis is an academic demo and no real patient or medical information should be entered.

Approved non-clinical escalation contact label

Review & refer

Confirm the practical-support request before creating the demo Non-Clinical Recovery Support Plan.

✓

Referral created.

The Non-Clinical Recovery Support Plan has been generated and added to the demo Navigator workspace in this browser.

Open Navigator workspace View patient plan