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The SDOH needs of a patient are usually determined by assessments. Based on the needs that were determined, the referral request should contain the relevant questions and answers from the assessment.

Currently the 360X-SD specification states:

An important part of the assessment is the interpretation of the answers. For this, we will add the use of OBX-8 and OBX-10, Interpretation Codes and Nature of Abnormal Test respectively.

(Add guidance for how the combination of question/response order specific questions and the diagnoses Z-codes correspond to the the FHIR Observation.interpretation). In the cases where additional assessments are done at the intermediary/consolidator or at the service provider, that information will available via the Referral Status Query.

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The request contains the determination of the clinician that the patient has specific needs, ranging from "Needs social services assessment" to specific services that need to be provided. In general, the needs are conveyed as "Reason for Referral" using ICD-10CM codes, while the goals/interventions are conveyed using SNOMED-CT codes.

Response to generic SDOH referrals

When the initial request is for a general service need determination, the closing of the loop can contain the results of a follow-up assessment. Further queries can be used to keep the status of the patient's social care services up to date.