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Patient-Facing REALD & SOGI Survey Tool

About the Survey Tool

image.png This secure, web-based form allows patients to enter their REALD and SOGI data for automatic reporting to the Oregon Health Authority (OHA).
  • Participating providers will get a customized survey link and QR code for their location.
  • Patients can then use the link or QR code to complete the REALD and SOGI questions.
  • Patients and providers can access the online REALD and SOGI survey by desktop or smartphone. 
  • REALD and SOGI data collected using this tool is then reported to OHA.
For questions about the online survey or REALD data collection requirements, email

How to access the Survey Tool

  1. Recommended: Provider team can load the Patient-Facing REALD & SOGI Survey Tool onto a smart device (i.e., tablet), refreshed for each new patient.
  2. Patients can scan the QR code from their smart device.
    • iOS: Place your camera over the QR Code and click the web address that appears.
    • Android: Place your camera over the QR code and click the web address or use the Google Lens App Scanner.
  3. Patients can type the link on their Internet connected device.
Safety and privacy:
  • REALD questions are optional.
    • You can choose “Don't want to answer."
    • Visit our FAQ to better understand how to answer REALD questions.
  • Sharing REALD data will not impact any benefits received from the state, like SNAP or Oregon Health Plan/CAWEM.
  • REALD information is treated as a confidential public health record.


REALD Resources

​REALD is an acronym that stan​​ds for race, ethnicity, language, and disability. House Bill 4212​ (2020 1st Special Session) ​requires health care providers to ask patients about REALD information at health care visits related to COVID-19. Then they share this information with OHA.

This requirement helps the state understand who is most impacted by COVID-19, so it can better provide funding and services to these communities. OHA worked with Oregon communities of color when developing this requirement, including Asian Pacific American Network of Oregon (APANO) and Oregon Health Equity Alliance (OHEA).

​Your answers to REALD questions will help us understand who is most affected by diseases like COVID-19, so we can work with these communities and learn how best to support them. We can also make sure the resources we provide are culturally appropriate and easily accessed by the groups that need them. 

For example, if we learn that one group of people has more COVID-19 cases than other groups, we can make sure that group gets more testing and resources like masks. ​

​It’s up to you whether you answer the REALD questions. While your provider is required to ask you all the REALD questions, you aren’t required to answer all of them. 

For questions you don’t want to answer, you can choose “Decline to answer.” 

OHA hopes you’ll answer these questions, so they can better serve you and all Oregonians.

​We want everyone to feel safe answering REALD questions. Your information is strictly confidential and will be treated as a confidential public health record. This means your information will not be shared with other agencies, including immigration officials.

OHA does not include your personal information, like name or date of birth, when reporting COVID-19 cases or race/ethnicity information to federal agencies like the Centers for Disease Control and Prevention. 

​Sharing your REALD data will not impact any benefits you receive from the state, like SNAP or Oregon Health Plan/CAWEM. This means your information will not be shared with other agencies, including immigration officials.

Fact sheet - REALD and COVID-19: English | Russian​ | Spanish | Vietnamese | Somali | Arabic ​| Korean | Simplified Chinese | Traditional Chinese | Chuukese | Marshallese | Hmong​​

Fact sheet - REALD and Disability Questions: English​ | Russian | Spanish | Vietnamese | Somali | Arabic | ​Korean | Simplified Chinese | Traditional Chinese | Chuukese | Marshallese | Hmong |​

Frequently asked questions

"What is Race, Ethnicity and Language, Disability (REALD)?​"Oregon Coronavirus Update​ (March 22, 2021)

Accommodation Information

​The Americans with Disabilities Act and Amendments Act of 2008​ (ADA) requires places of public accommodation like medical offices take appropriate steps to ensure that communications and access to services for individuals with disabilities are as effective as those for individuals who do not have disab​ilities.  

  • ​The NW ADA Center has a great Healthc​are Toolkit and resources on how to meet your obligations under the ADA.

The Centers for Medicare & Medicaid Services Office of Minority Health works to ensure that people with disabilities receive equal access to quality health care information and services. 

​The ADA requires that a provider pay for the cost of interpreter services as an accommodation for an individual with a disability as long as the aid or service does not impose an undue burden on the business.  

  • The provider must demonstrate undue burden, which is based on all resources available to the provider (not solely on a comparison between what the provider is paid for that individual appointment compared to the cost of the interpreter). 
  • If the use of an interpreter would result in an undue burden, the provider must still work with the patient to determine an alternative aid or service.

Please visit​ for more information. 

​The NW ADA Center​ offers consultations and technical assistance. 

The Oregon Association of the Deaf provides local resources and information on Deaf and hard of hearing services.

The National Association of the Deaf​ also offers consultations and technical assistance.