Refer to Metra Services

1

Member identity

One block per household member. Sections 2–4 below are shared across everyone you add here.

Each member becomes its own SCN referral (own MA ID, own screening, own eligibility) — they share an address and household ID.

Household members * — total at this address

Counts everyone living here, even those not being enrolled.

2

Contact

Phone, email, and full mailing address

Phone *

Auto-formats as you type

Email *

How would you like to be contacted? *

Email Phone

Street address * — start typing, pick from suggestions to validate

✓ Address validated via Mapbox

⚠ Not validated — pick a Mapbox suggestion for the most reliable duplicate-detection.

Looking up…

Apt / Unit / Floor

Enter manually — not part of validation.

City * (optional)

Borough * (auto-fills from ZIP)

State

ZIP * (5 digits)

3

Presenting need

What categories does this member need help with? AHC screening will refine these.

Need categories *

Housing instability Food insecurity Transportation Utilities help Employment Education

Free-text description *

4

Health

Two quick screening questions about the household.

Are you, or anyone in your household, currently pregnant or postpartum (with a baby younger than 12 months)? *

Yes No

Do you, or anyone in your household, currently have an active or chronic medical condition? *

Yes No

5

Source

Where did this referral come from?

Referring organization

RNYC

Source is locked for this intake.

intake questions

A few questions from this company to complete the referral.

Notes

Anything else we should know? (optional)