TABLE 1:

Screener for social determinants of health

Housing	Do you currently live in a shelter or have no steady place to sleep at night?	Yes/No
	Do you think you are at risk of becoming homeless?	Yes/No
	If yes, is this an emergency?	Yes/No
Food	Within the past 12 months, the food you bought didn’t last and you didn’t have money to get more.	Often true/sometimes true/never true
	Within the past 12 months, you worried whether your food would run out before you got money to buy more.	Often true/sometimes true/never true
	Is this an emergency? Do you need food for tonight?	Yes/No
Medication	Do you have trouble paying for medicines?	Yes/No
Transportation	Do you have trouble getting transportation to medical appointments?	Yes/No
Utilities	Do you have trouble paying your heating or electricity bill?	Yes/No
	If yes, are you at risk of having your utilities shut off in the next week?	Yes/No
Daycare	Do you have trouble taking care of a child, family member, or friend?	Yes/No
Employment	Are you currently unemployed and looking for a job?	Yes/No
Education	Are you interested in more education?	Yes/No

Would you like help connecting to resources? Please circle below
Housing/shelter	Food	Paying for medication	Transportation to medical appointments
Utilities	Daycare	Job search/training	Education