SDOH screening intake

PRAPARE survey with community-resource referrals and follow-up loop.

Community Health Center · Social Determinants Intake

The Whole-Person Intake

"ask the question, sit with the answer."

PRAPARE · Z-codes auto-mapped · Spanish

Marisol Vargas · 41F

Sunset Family Medicine

01.Race / ethnicity

02.How many people live in your household?

03.What is your housing situation?

04.Within the past 12 months, were you worried food would run out?

05.Has lack of transportation kept you from medical appts or work?

06.In the past 12 months, has the utility company shut off service?

07.Do you feel physically and emotionally safe where you currently live?

08.In the past year, have you been hurt or threatened by someone?

09.What is your current employment status?

10.Highest level of school completed

11.How often do you feel stressed about money?

SDOH Risk Score

0/22

low risk

Suggested Referrals

No flagged domains yet.

Population health · Care management

Who's been screened, what risks surfaced, and how many got connected to a community resource.

Synthetic data

Food insecurity412

Housing instability318

Transportation244

Utilities188

Interpersonal safety88

Connectors used

Health Records

required

Redox / Particle Health

Store PRAPARE responses in the chart

Patient Scheduling

required

NexHealth / Tebra

Schedule community-resource follow-up

Microsoft Word

optional

Generate referral letters to CBOs

Twilio (BAA)

optional

Reminder SMS for follow-up steps