Provider resources for the social and structural determinants of health

If your patient has been charged with a criminal or civil offense, this resource provides guidance in writing a letter to highlight how a medical condition, mental illness, or disability has contributed to their involvement in the legal system.

If incarceration will impact your patient’s medical or mental health, this resource will help you to write a letter advocating that a prison sentence not be imposed on your patient.

If, in your assessment, your patient has missed a required court appearance due to an underlying physical or mental health condition and is at risk of facing legal punishment, this resource will help you to write a letter advocating that your patient not be penalized for missing a court date.

If your patient would like to legally change their name or gender marker on paperwork including birth certificate, license, or passport, this resource will allow you to write a letter in support of this change by outlining the adverse impacts of gender dysphoria and the importance of gender affirming care.

If your patient is living in poor or unsafe housing conditions that are negatively affecting their health, including concerns related to overcrowding, rodents, roaches, mold, lead exposure, or utilities, this resource will allow you to write a letter to the landlord explaining the impacts of these conditions on your patient’s health and advocating for timely changes to be made.

If your patient wishes to be housed with animals whom they identify as supportive to them, this resource provides guidance for writing a letter that allows an individual to bring an animal into a building or other place that prohibits pets, and/or waives a deposit fee.

If your patient is seriously ill or has a disability and is at risk of having their utilities shut-off, this form will allow you to advocate for a deferral of service termination.

If your patient is applying for U.S. citizenship but has a disabling condition that prevents them from learning English and/or U.S. history and civics, this resource will help you provide the medical documentation necessary to support a patient's request for exemption from the English language and civics portions of the citizenship test.

If your patient is very medically sick and has family members residing outside of the country who are unable to visit due to immigration policies, this resource will help you write a letter advocating for the patient’s relatives to be allowed to temporarily visit the United States.

If, in your assessment, deportation will impact your patient’s medical or mental health, this resource will help you to write a letter advocating for your patient not to be deported from the United States by immigration officials.

If your patient has a disabling medical condition and is experiencing homelessness or at risk of homelessness, this resource will help you complete documentation that helps a patient apply for SSI/SSDI benefits.

If your patient is seriously ill or has a disability and is at risk of having their utilities shut-off, this form will allow you to advocate for a deferral of service termination.

If your patient has a disability and has difficulties paying for public transportation, this resource will help you write a letter advocating for your patient to receive a two-year disability bus pass.

If your patient experiences transportation difficulties and could use assistance to attend non-emergency healthcare appointments, this resource will help you complete documentation that helps a patient apply for MTM services.

If your patient has a disability and needs a disability parking placard for their vehicle, this resource will help you fill out the application form.

If your patient has a disability and has difficulties paying for public transportation, this resource will help you write a letter advocating for your patient to receive a two-year disability bus pass.