A Social Determinant’s of Health Questionnaire created by People’s Community Clinic in Austin, TX to help assess patient’s social needs. It is intended to be used by organizations of all types working with underserved clientele, who can add their own logo and choose whether they are targeting clients, patients, or residents. Organizations can connect the domains to various resources that are available in their community to help address individual’s social needs (e.g. Medical-Legal Partnerships, Food Access Programs, Education Programs, etc.). Additionally, a larger purpose is to create a shareable data base which can be aggregated in order to create systemic change. In order to help us with this latter piece, we would appreciate you letting us know if you are planning on using the tool by emailing Cherelle Vanbrakle at Cherelle.Vanbrakle@austinpcc.org.
You may download as a PDF, or the customizable Word document here.