Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Form Context

Questions 1-10 are reprinted with permission from the National Academy of Sciences, courtesy of the National Academies Press, Washington, D.C

Source: American Academy of Family Physicians

71802-3 What is your housing situation today?

Term Description

Describes patients living arrangement

Observation ID in Form

1

Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Form Coding Instructions

Choose all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Housing status
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Housing status

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.72 (MIN)
Order vs. Observation
Observation

Normative Answer List LL5876-9

AnswerCodeScoreAnswer ID
I have a steady place to liveLA31993-1
I have a place to live today, but I am worried about losing it in the futureLA31994-9
I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)LA31995-6

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
111530-2Housing Question Set Condensed [Housing Question Set Condensed]
112505-3Housing Question Set Extended [Housing Question Set Extended]
93025-5Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

96778-6 Think about the place you live. Do you have problems with any of the following?

Observation ID in Form

2

Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Problems with place where you live
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Problems with place where you live

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.70 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5877-7

AnswerCodeScoreAnswer ID
Pests such as bugs, ants, or miceLA31996-4
MoldLA28580-1
Lead paint or pipesLA31997-2
Lack of heatLA31998-0
Oven or stove not workingLA31999-8
Smoke detectors missing or not workingLA32000-4
Water leaksLA32001-2
None of the aboveLA9-3

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

88122-7 Within the past 12 months, you worried that your food would run out before you got money to buy more

Observation ID in Form

3

Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Within the past 12Mo we worried whether our food would run out before we got money to buy more
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Within the past 12 months we worried whether our food would run out before we got money to buy more

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.63
Last Updated
Version 2.81 (MAJ)
Change Reason
Release 2.70: AnswerListId: Updated answer list to align with form;
Order vs. Observation
Observation

Normative Answer List LL5890-0

AnswerCodeScoreAnswer ID
Often trueLA28397-0
Sometimes trueLA6729-3
Never trueLA28398-8

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
88121-9Children's HealthWatch Hunger Vital Sign [HVS]
95353-9U.S. Adult Food Security Survey - 10-item Form [U.S. FSS - Adult]
95246-5U.S. Household Food Security Survey - 18 Item Form [U.S. FSS-18]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

88123-5 Within the past 12 months, the food you bought just didn't lat and you didn't have money to get more

Observation ID in Form

4

Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Within the past 12Mo the food we bought just didn't last and we didn't have money to get more
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Within the past 12 months the food we bought just didn't last and we didn't have money to get more

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.63
Last Updated
Version 2.81 (MAJ)
Change Reason
Release 2.81: TIME_ASPCT: corrected time aspect; METHOD_TYP: remove method from survey Qs; Release 2.70: AnswerListId: Updated answer list to align with form;
Order vs. Observation
Observation

Normative Answer List LL5890-0

AnswerCodeScoreAnswer ID
Often trueLA28397-0
Sometimes trueLA6729-3
Never trueLA28398-8

Member of these Panels

LOINCLong Common Name
107617-3Abbreviated Child and Adult Food Security Scale [ACAFSS]
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
88121-9Children's HealthWatch Hunger Vital Sign [HVS]
95353-9U.S. Adult Food Security Survey - 10-item Form [U.S. FSS - Adult]
95246-5U.S. Household Food Security Survey - 18 Item Form [U.S. FSS-18]
95361-2U.S. Household Food Security Survey - Six-Item Short Form [U.S. FSS-6]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

99594-4 In the past 12 months, has lack of transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?

Observation ID in Form

5

Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Delayed medical care due to distance or lack of transportation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Delayed medical care due to distance or lack of transportation

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6155-7

AnswerCodeScoreAnswer ID
Yes, it has kept me from medical appointments or getting medicationsLA33093-8
Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I needLA30134-3
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form

96779-4 In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?

Observation ID in Form

6

Form Context

Billioux A, Verlander K, Anthony S, and Alley D. National Academy of Medicine. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. National Academies Press. Washington, D.C. https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf. Accessed November 14, 2017

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Has the electric, gas, oil, or water company threatened to shut off services in your home in past 12Mo
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Has the electric, gas, oil, or water company threatened to shut off services in your home in past 12 months

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.70
Last Updated
Version 2.70 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5878-5

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)0LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)1LA32-8
Already shut off2LA32002-0

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
99549-8Health Leads screening panel

95619-3 Hurts, insults, threatens, and screams [HITS]

Term Description

The Hurt-Insult-Threaten-Scream (HITS) screening tool was developed as a quick, four question, domestic violence screen. Each response has a corresponding numeric value, ranging from 1(rarely) to 5 (frequently). The four individual values are summed for a total score between 4 and 20. A cumulative score greater than 10 indicates the possibility of domestic partner abuse. PMID: 24652635

Fully-Specified Name

Component
Hurts, insults, threatens, and screams
Property
-
Time
12Mo
System
^Patient
Scale
-
Method
HITS

Basic Attributes

Class
PANEL.SURVEY.HITS
Type
Surveys
First Released
Version 2.69
Last Updated
Version 2.72 (PANEL)
Order vs. Observation
Order
Panel Type
Panel

Member of these Panels

LOINCLong Common Name
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

95618-5 How often does anyone, including family, physically hurt you?

Observation ID in Form

7

Form Context

Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30(7):508-512

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Physically hurt you
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Physically hurt you

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.69
Last Updated
Version 2.82 (MIN)
Order vs. Observation
Observation

Normative Answer List LL6156-5

AnswerCodeScoreAnswer ID
NeverLA6270-8
RarelyLA10066-1
SometimesLA10082-8
Fairly oftenLA16644-9
FrequentlyLA6482-9

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
106931-9Extended hurt, insulted, threaten, scream [E-HITS]
95619-3Hurts, insults, threatens, and screams [HITS]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

95617-7 How often does anyone, including family, insult or talk down to you?

Observation ID in Form

8

Form Context

Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30(7):508-512

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Insult you or talk down to you
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Insult you or talk down to you

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.69
Last Updated
Version 2.82 (MIN)
Order vs. Observation
Observation

Normative Answer List LL6156-5

AnswerCodeScoreAnswer ID
NeverLA6270-8
RarelyLA10066-1
SometimesLA10082-8
Fairly oftenLA16644-9
FrequentlyLA6482-9

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
106931-9Extended hurt, insulted, threaten, scream [E-HITS]
95619-3Hurts, insults, threatens, and screams [HITS]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

95616-9 How often does anyone, including family, threaten you with harm?

Observation ID in Form

9

Form Context

Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30(7):508-512

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Threaten you with physical harm
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Threaten you with physical harm

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.69
Last Updated
Version 2.82 (MIN)
Order vs. Observation
Observation

Normative Answer List LL6156-5

AnswerCodeScoreAnswer ID
NeverLA6270-8
RarelyLA10066-1
SometimesLA10082-8
Fairly oftenLA16644-9
FrequentlyLA6482-9

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
106931-9Extended hurt, insulted, threaten, scream [E-HITS]
95619-3Hurts, insults, threatens, and screams [HITS]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

95615-1 How often does anyone, including family, scream or curse at you?

Observation ID in Form

10

Form Context

Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30(7):508-512

Source: American Academy of Family Physicians

Fully-Specified Name

Component
Scream or curse at you
Property
Find
Time
12Mo
System
^Patient
Scale
Ord
Method

Long Common Name

Scream or curse at you

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.69
Last Updated
Version 2.82 (MIN)
Order vs. Observation
Observation

Normative Answer List LL6156-5

AnswerCodeScoreAnswer ID
NeverLA6270-8
RarelyLA10066-1
SometimesLA10082-8
Fairly oftenLA16644-9
FrequentlyLA6482-9

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
106931-9Extended hurt, insulted, threaten, scream [E-HITS]
95619-3Hurts, insults, threatens, and screams [HITS]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

95614-4 Total score [HITS]

Fully-Specified Name

Component
Total score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
HITS

Basic Attributes

Class
SURVEY.HITS
Type
Surveys
First Released
Version 2.69
Last Updated
Version 2.69 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
96777-8Accountable health communities (AHC) health-related social needs screening (HRSN) tool
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
95619-3Hurts, insults, threatens, and screams [HITS]

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH

Example Units

UnitSource
{score}Example UCUM Units

99555-5 Would you like help with any of these needs?

Observation ID in Form

11

Fully-Specified Name

Component
Want assistance with personal needs
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Want assistance with personal needs

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
99593-6American Academy of Family Physicians Social Needs Screening Tool
99595-1American Academy of Family Physicians Social Needs Screening Tool - short form
99549-8Health Leads screening panel

Member of these Groups Get Info

LOINC GroupGroup Name
LG51306-5SDOH