University of San Francisco California
Financial Strain Questions
AAFP Social Needs Screening Tool
How often does this describe you? I don’t have enough money to pay my bills:
Never
Rarely
Sometimes
Often
Always
Accountable Health Communities Health-Related Social Needs Screening Tool
Supplemental: How hard is it for you to pay for the very basics like food, housing, medical care, and heating? Would you say it is:
Very hard
Somewhat hard
Not hard at all
Arlington Screening Tool
In the past year have you or any of your family members been unable to get any of the following when it was really needed.
CHECK ALL THAT APPLY
Food
Clothing
Utilities
Child care
Medicine or any health care (medical, dental, mental health or vision)
Other (please write in notes)
Do not have problems meeting my needs
HealthBegins Upstream Risk Screening Tool
Do you ever have problems making ends meet at the end of the month?
Yes/No
How hard is it for you to pay for the very basics like food, housing, medical care, and heating? Would you say it is..
Very hard
Somewhat hard
Not hard at all
National Academy of Medicine Domains
How hard is it for you to pay for the very basics like food, housing, medical care and heat?
Structural Vulnerability Assessment Tool
Do you have enough money to live comfortably-pay rent, get food, pay utilities, telephone?
Do you depend on anyone else for income?
Have you ever been unable to pay for medical care or for medicines at the pharmacy?
Kaiser Permanente's Your Current Life Situation Survey
In the past 3 months, did you have trouble paying for any of the following? (Select ALL that apply)
Food
Housing
Heat and electricity
Medical needs
Transportation
Childcare
Debts
Other
None of these