Get Social Needs Screening Tool (patient Short Form)

Completing the Social Needs Screening Tool (Patient Short Form) online is an essential step in assessing various social determinants that may impact your health. This guide will walk you through the process, ensuring you can fill out the form accurately and efficiently.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin with the housing section. Indicate your current housing situation by selecting one of the options provided. If applicable, detail any problems you may have with your living environment, such as issues with pests or heating.
3. Move to the food section. Answer questions regarding your concerns about food availability within the past 12 months to understand your food security situation.
4. In the utilities section, provide information on whether you have faced any threats of service shutdowns for electric, gas, oil, or water. This will help assess your access to essential utilities.
5. Personal safety is the next section. Here, respond to questions about experiences of physical harm or threats, ensuring to indicate the frequency of these occurrences.
6. Transportation-related inquiries follow. Indicate whether lack of transportation has hindered your ability to attend appointments or obtain daily necessities.
7. Finally, let us know if you would like assistance with any of your identified needs by selecting 'Yes' or 'No.' This is crucial for connecting you with necessary resources.
8. Once all sections of the form are filled out, review your answers for accuracy. After verifying everything, you can save changes, download, print, or share the completed form as required.

Start completing your Social Needs Screening Tool online today to better understand and address your social needs.