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Patient-Facing REALD Data Collection Tool

About the Tool

This secure, web-based form allows patients to enter their Race, Ethnicity, Language, and Disability (REALD) 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 questions.
  • REALD data collected using this tool is then reported to OHA.

OHA will add Sexual Orientation and Gender Identity (SOGI) data collection in 2023.

Information for Patients and Partners

Patients and providers can access the online REALD survey by desktop or smartphone. 

​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.

Information for Providers


The need for REALD was identified by community groups here in Oregon who didn't see their communities represented in the data. They knew their communities were experiencing health burdens but could not find their experiences represented adequately in the data. This was, in part, due to the way that demographic data is/was collected. REALD is designed to update demographic data collection to be more inclusive. Oregon law now requires health care providers to ask patients about REALD information, once each year.

REALD Patient-Facing Survey Tool (PFST)

What: A secure, web-based form that allows patients to enter their Race, Ethnicity and Language, Disability (REALD) data for automatic reporting to the Oregon Health Authority (OHA).

How: Patients access the REALD questionnaire through the QR code or link below.

  1. Recommended: Provider team can load the questionnaire onto a smart device (i.e., tablet), refreshed for each new patient.
  2. Patients can scan the QR code from their smart device.
    1. iOS: Place your camera over the QR Code and click the web address that appears.
    2. 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:

  1. Patients choose whether they answer the REALD questions.
    1. For questions that a person doesn't' want to answer, choose “Don't want to answer."
  2. Sharing REALD data will not impact any benefits received from the state, like SNAP or Oregon Health Plan/CAWEM.
  3. We want everyone to feel safe answering REALD questions. REALD information is strictly confidential and will be treated as a confidential public health record.
  4. Learn more about REALD at
  5. We hope everyone will answer these questions, to better serve all Oregonians.

Interested in using the PFST in your practice?

Please fill out this form and our team will reach out to you. 

Quick Links

Provider request form

Learn about REALD

Information for providers

Information for patients

Frequently asked questions

Need Help?

To get help using the online survey, providers and patients can contact ARIAS Support:

For questions about the online survey or REALD data collection requirements, email OHA REALD Questions.