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Medicare # Cash Insurance Carrier name Group # ID# North Carolina Screening Questionnaire and Consent Form Patient Information: (Patient to complete*) *Patient Name: *Date of Birth: *Age: *Phone#.

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SDOH screening tools ask about various topics such as finances, family and community support, education, physical activity, substance use, mental health, and disabilities.

NCCARE360 is the first statewide coordinated care network to electronically connect those with identified needs to community resources and allow for a feedback loop on the outcome of that connection.

SDOH can be grouped into 5 domains: Economic Stability. Education Access and Quality. Health Care Access and Quality. Neighborhood and Built Environment. Social and Community Context.

In the 2023 IPPS Final Rule, CMS mandated that hospitals reporting to the Inpatient Quality Reporting (IQR) program submit two brand new measures: SDOH-1 and SDOH-2. These measures are voluntary in 2023 and required by 2024.

SDOH screening tools ask about various topics such as finances, family and community support, education, physical activity, substance use, mental health, and disabilities.

Within SDOH, socioeconomic factors such as poverty, employment, and education have the largest impact on health outcomes.

Measures: The Core 5 SDH screening tool consists of five yes/no items assessing food, housing, utilities, transportation, and safety needs.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232