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Resource Submission Form
Contact Information
Hospital
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Partners
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Resource Contact Name
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Resource contact Email Address
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Can this email address be used to allow others to contact you about your program?
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Yes, other essential hospitals can contact me directly about my program.
No, I prefer to be contacted by America's Essential Hospitals if someone is interested in my program.
Resource Information
Resource Name
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Social Determinant(s) Addressed by Resource (select up to 3)
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2
3
4
5
6
Community Infrastructure
Education
Employment & Income
Family & Social Support
Food Insecurity
Health Behaviors
Health Literacy
Housing Instability
Interpersonal Violence
Legal Needs
Transportation
Utility Needs
Use Ctrl to select up to three
Primary Social Determinant Addressed by Resource
*
Climate Vulnerability
Community Infrastructure
Education
Employment & Income
Family & Social Support
Food Insecurity
Health Behaviors
Health Literacy
Housing Instability
Interpersonal Violence
Legal Needs
Social Needs Screening
Transportation
Utility Needs
Structural Racism
Please select one option
Strategy
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COVID-19
HIT Systems & Analysis
Hospital Readiness/Community Assessment
Multisector Partnerships
Program Implementation
Strategic Planning
Sustainable Funding
Workforce Capacity
Employee Engagement
Procurement
Please select one option
In 1-2 sentences, please describe the resource.
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In 1-2 sentences, please describe how essential hospitals can utilize the resource.
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Please provide an active link to your resource.
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If you are human, leave this field blank.
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