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General Health Screening

  • Medical Evaluation & Screening

    • History & Physical Exams

    • Portable Diagnostics

      • Ultrasound, EKG, Glucose Test Kits, Lipid Panel, etc.

  • Social History

    •  Risk stratification for care coordination

Medical and essential services 

  • Chronic Disease Management

    • Hypertension, Diabetes, etc. ​

  • Medication Management

    • Over the counter and prescription medication.

  • Wound Care

  • Braces, slings, compression socks, hygiene kits, etc.

Education & Counseling

  • Motivational interviewing

    • Facilitated by an addiction specialist and/or counselor

  • Provide information about medical conditions & healthcare system

Building Trust 

  • Kits and Items

  • Empathetic listening; Volunteerism

    • Foot Washing, Delivering meals, etc

  • Counseling services

Care Coordination

  • Brokerage Model 

  • Longitudinal Follow Up and Patient Advocacy


Area of Operations

Our Workflow

Custom EMR built REDCap

Every week before street rounds, we review all patient agreements, medical notes, and case management updates. Each individual service plan is synthesized into a priority patient list for that week’s street rounds. Then, our street team leaders guide a multidisciplinary team (physicians, researchers, mental health professional, and case workers) out to meet our patients under bridges and in encampments to follow up with each person. In other words, we go to the people.

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