diff --git a/portal/trigger_states/empro_states.py b/portal/trigger_states/empro_states.py
index b20927882..e9798445e 100644
--- a/portal/trigger_states/empro_states.py
+++ b/portal/trigger_states/empro_states.py
@@ -13,7 +13,7 @@
 
 from .empro_domains import DomainManifold
 from .empro_messages import invite_email, patient_email, staff_emails
-from .models import TriggerState
+from .models import TriggerState, opted_out_previous_key
 from ..database import db
 from ..date_tools import FHIR_datetime
 from ..models.qb_status import QB_Status
@@ -295,6 +295,13 @@ def process_processed(ts):
         # on hard triggers.  Patient gets 'thank you' email regardless.
         hard_triggers = ts.hard_trigger_list()
         soft_triggers = ts.soft_trigger_list()
+        opted_out = ts.opted_out_domains()
+        actionable_triggers = list(set(hard_triggers) - set(opted_out))
+        # persist all opted out for front-end use as well
+        for domain, link_triggers in triggers['domain'].items():
+            if domain in opted_out:
+                link_triggers[opted_out_previous_key] = True
+
         pending_emails = []
         patient = User.query.get(ts.user_id)
 
@@ -307,11 +314,10 @@ def process_processed(ts):
             current_app.logger.error(
                 f"EMPRO Patient({patient.id}) w/o email!  Can't send message")
 
-        if hard_triggers:
+        if actionable_triggers:
             triggers['action_state'] = 'required'
-
             # In the event of hard_triggers, clinicians/staff get mail
-            for msg in staff_emails(patient, hard_triggers, True):
+            for msg in staff_emails(patient, actionable_triggers, True):
                 pending_emails.append((msg, "initial staff alert"))
 
         for em, context in pending_emails:
@@ -322,8 +328,8 @@ def process_processed(ts):
         sm = EMPRO_state(ts)
         sm.fired_events()
 
-        # Without hard triggers, no further action is necessary
-        if not hard_triggers:
+        # Without actionable triggers, no further action is necessary
+        if not actionable_triggers:
             sm.resolve()
 
         current_app.logger.debug(
diff --git a/portal/trigger_states/models.py b/portal/trigger_states/models.py
index 300c2aff5..e943b0934 100644
--- a/portal/trigger_states/models.py
+++ b/portal/trigger_states/models.py
@@ -9,7 +9,9 @@
 from ..date_tools import FHIR_datetime, weekday_delta
 from ..models.audit import Audit
 
-opt_out_key = '_opt_out_next_visit'
+opt_out_next_visit_key = '_opt_out_next_visit'
+opted_out_previous_key = '_opted_out_previous_visit'
+
 
 trigger_state_enum = ENUM(
     'unstarted',
@@ -108,16 +110,16 @@ def apply_opt_out(self, opt_out_dict):
 
         opt_out_of_domains = set()
         for d, vals in opt_out_dict['triggers']['domains'].items():
-            if vals.get(opt_out_key) is True:
+            if vals.get(opt_out_next_visit_key) is True:
                 opt_out_of_domains.add(d)
 
         tc = deepcopy(self.triggers)
         for domain, link_triggers in tc['domain'].items():
             if domain in opt_out_of_domains:
-                link_triggers[opt_out_key] = True
+                link_triggers[opt_out_next_visit_key] = True
                 opt_out_of_domains.remove(domain)
-            elif opt_out_key in link_triggers:
-                link_triggers.pop(opt_out_key)
+            elif opt_out_next_visit_key in link_triggers:
+                link_triggers.pop(opt_out_next_visit_key)
 
         if opt_out_of_domains:
             raise ValueError(
@@ -143,6 +145,27 @@ def hard_trigger_list(self):
                 results.append(domain)
         return sorted(results)
 
+    def opted_out_domains(self):
+        """Convenience function to return list of opted out previous visit domains
+
+        :returns: list of domains user opted out of on previous visit, or empty list.
+        """
+        results = []
+        if not self.triggers:
+            return results
+
+        # need previous month triggers for this one
+        prev = self.query.filter(TriggerState.user_id == self.user_id).filter(
+            TriggerState.visit_month == self.visit_month - 1).filter(
+            TriggerState.state == 'resolved').first()
+        if not (prev and prev.triggers):
+            return results
+
+        for domain, link_triggers in prev.triggers['domain'].items():
+            if opt_out_next_visit_key in link_triggers:
+                results.append(domain)
+        return results
+
     def reminder_due(self, as_of_date=None):
         """Determine if reminder is due from internal state"""
         # locate first and most recent *staff* email
diff --git a/tests/test_trigger_states.py b/tests/test_trigger_states.py
index f190ec46a..df35beaed 100644
--- a/tests/test_trigger_states.py
+++ b/tests/test_trigger_states.py
@@ -182,12 +182,12 @@ def test_worsening_baseline():
 
 
 def test_apply_opt_out(initialized_patient, processed_ts, opt_out_submission):
-    from portal.trigger_states.models import opt_out_key
+    from portal.trigger_states.models import opt_out_next_visit_key
     # apply opt out request
     user = db.session.merge(initialized_patient)
     ts = users_trigger_state(user.id)
     result = ts.apply_opt_out(opt_out_submission)
-    found = [k for k,v in result.triggers['domain'].items() if opt_out_key in v]
+    found = [k for k,v in result.triggers['domain'].items() if opt_out_next_visit_key in v]
     assert len(found) == 2