This template supports practices in implementing and documenting standardized depression and substance use disorder screening, follow-up, and referral processes. It guides practices through establishing baseline performance, defining staff roles and screening workflows, documenting triage and referral protocols, tracking closed-loop referrals, and reporting implementation progress. Practices use the template to describe how screening data are collected and stored, how patients with positive screens are connected to appropriate services, and how referral outcomes are monitored. It also includes required measures for depression and substance use disorder screening, linkage to services, and closed-loop referrals, along with guidance for documenting new implementation activities and results. The template is intended as a structured reference for preparing the required EPT deliverable submission.