This template supports practices in completing the EPT Health-Related Social Needs Screening and Linkage milestone. It guides practices through documenting their HRSN screening population, screening tools, staff roles, workflows, triage and intervention protocols, referral processes, community partnerships, data collection, and staff training. Practices also use the template to report baseline and current performance measures, describe actions implemented to strengthen screening and service linkage, track closed-loop referral outcomes, and document quantitative or qualitative results. The completed submission should reflect the practice’s own patient population, workflows, data systems, partnerships, and implementation experience.