| 93025-5 | Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences |
| 93026-3 | Do you feel physically and emotionally safe where you currently live (qualitative) |
| 93028-9 | Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year (qualitative) |
| 93029-7 | How often do you see or talk to people that you care about and feel close to (qualitative) |
| 93031-3 | Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year |
| 93033-9 | Are you worried about losing your housing (qualitative) |
| 93035-4 | Has season or migrant farm work been your or your family's main source of income at any point in past 2 years (qualitative) |
| 93039-6 | Optional additional questions |
| 93040-4 | Social and emotional health |
| 93041-2 | Money and resources |
| 93042-0 | Family and home |
| 93043-8 | Personal characteristics |