Social Determinants of Health Screening

The Social Determinants of Health (SDOH) Screening form assesses the non-medical factors that significantly impact health outcomes: food security, housing stability, transportation access to healthcare, financial strain, personal safety (including interpersonal violence), social isolation, and education/health literacy. These factors account for an estimated 80% of health outcomes, making screening essential for whole-person care.

This template is based on validated screening tools recommended by CMS and major healthcare organizations, including elements from the PRAPARE, AHC-HRSN, and AAFP screening instruments. Questions are worded in plain language and normalized to reduce stigma -- for example, framing food security as 'within the last 12 months, were you worried about running out of food before you could buy more?' rather than clinical terminology.

Positive screens generate referral pathways to community resources: food banks, housing assistance, transportation services, financial counseling, and domestic violence support. The form tracks screening dates and follow-up actions, supporting the closed-loop referral processes required by many value-based care contracts and health plan quality measures. This template supports CMS quality measures, NCQA HEDIS requirements, and state Medicaid SDOH screening mandates.