Social Determinants of Health Screening
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Social Determinants of Health Screening
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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.
What's included
- Food, housing, and transportation screening
- Financial strain and utility assessment
- Personal safety and violence screening
- Social isolation and support evaluation
- Patient-directed resource referral
- Closed-loop follow-up tracking
Who uses this template
- Primary care and community health centers
- Value-based care and ACO programs
- Medicaid managed care screening requirements
- Population health and equity programs
All form fields
11 fields across 2 pages. Customize any field after signing up.
How to use the Social Determinants of Health Screening
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Social Determinants of Health Screening from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Social Determinants of Health Screening in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 11 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Social Determinants of Health Screening HIPAA compliant?
Yes. All Formisoft templates, including the Social Determinants of Health Screening, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 11 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Social Determinants of Health Screening is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
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