JD
Housing Instability
12%
1,012 members
Food Insecurity
18%
1,518 members
Transportation
9%
759 members
Social Isolation
15%
1,265 members
Financial Strain
22%
1,855 members
SDOH Assessment Results
MemberScreen DatePrimary NeedSecondary NeedRisk LevelReferral StatusActions
Maria C.
M001-3821
Jan 15, 2026Food InsecurityFinancial StrainHighPending
James W.
M002-7741
Jan 12, 2026Housing InstabilityFood InsecurityCriticalConnected
Patricia K.
M003-5512
Jan 10, 2026TransportationModerateConnected
Robert G.
M004-8833
Jan 8, 2026Financial StrainSocial IsolationModerateNot Referred
Linda H.
M005-1124
Jan 5, 2026Social IsolationFinancial StrainModerateIn Progress
David S.
M006-4490
Dec 28, 2025Food InsecurityTransportationHighPending
Top ZIP Codes by SDOH Need
Members with 2+ identified SDOH needs
94110
68%
94112
54%
94124
47%
94134
41%
94102
38%
Community Resources
Active referral partners in network
SF-Marin Food Bank
Food Insecurity • Active partner
Active
HomeFirst Services
Housing • 47 referrals YTD
Active
211 SF Transportation
Transportation • 23 referrals YTD
Active
Benefits Enrollment Center
Financial • 89 referrals YTD
New Partner
Page Guide

The SDOH Data page captures and tracks social determinants of health screening results across your enrolled population using the PRAPARE and AHC screening tools.

Domain cards show the prevalence of each SDOH need. The assessment table shows individual screening results. ZIP-level maps identify geographic hotspots.

Schedule regular SDOH screenings at annual wellness visits. Connect members with community resources promptly — early referral improves both health outcomes and Stars scores.

New SDOH Assessment
Member Detail