This English-language screening tool helps healthcare teams identify health-related social needs that may affect a patient’s health and ability to access care. It includes questions related to areas such as housing, food, utilities, transportation, medications, caregiving, legal needs, family stress, and personal safety. The tool can also help practices understand whether patients would like assistance addressing an identified need. Practices may use this resource to support standardized HRSN screening, inform referrals and follow-up, and strengthen connections to community services. Screening processes should include clear response protocols, appropriate privacy protections, and workflows for documenting and addressing identified needs.