Registration Personal Details Username* First Name* Last Name* Email* Password* Confirm Password* Pronouns Website Biographical Info Organization Organization Name* Type of Organization* Select the option that best applies Community/Migrant/Homeless/Public Housing Health Center or Federally-Qualified Health Center Designated as a health center Look-alike Hospital Health System Multi-specialty Practice Accountable Care Organization Managed Care Organization/Health Plan Social Services Organization Community Based Organization Faith Based Organization Government agency (local/state/federal) Primary Care Association and/or Health Center Controlled Network National Training and Technical Assistance Partner (NTTAP) Other If Other Organization, please specify Job Title/Role* State/Province* Geographical Service Area* Frontier Rural Suburban Urban N/A Is your organization currently screening patients/clients for SDOH needs?* Yes No Unsure N/A If you are screening patients/clients for SDOH needs, please specify which tool your organization uses. Accountable Health Communities Screening Tools Upstream Risks Screening Tool and Guide iHELP Recommend Social and Behavioral Domains for EHRs Protocol for Responding to and Assessing Patients' Assets, Risks and Experiences (PRAPARE) Well Child Care Evaluation Community Resources Advocacy Referral Education (WE CARE) WellRx Screening tools built into EHR We do not use a standardized screener We use or support a screener that is not on this list N/A Please select which populations are served at your organization with specific, tailored programs/services to meet their SDOH needs. (Select up to 3 groups using crtl + click)* School aged-children and adolescents Older adults Maternal health Refugees New immigrants Migratory and seasonal agricultural workers Individuals experiencing homelessness Residents of public housing LGBTQIA+ (Lesbian, gay, bisexual, transgender, queer, intersex, asexual ) Individuals experiencing intimate partner violence or domestic violence Returning citizens/persons previously incarcerated Veterans N/A Please select which racial and ethnic groups are served at your organization with specific, tailored programs/services to meet their SDOH needs. (Select all that apply using crtl + click)* Black/African American/African Hispanic/Latinx Central and South American Caribbean Native Americans Alaskan Native Tribes Asian/Asian Americans Native Hawaiians and Pacific Islanders Southeast Asians Middle Eastern/Arabic N/A