The primary care setting is increasingly being called upon to address not only the medical needs of their patients, but also the social determinants of health that contribute to their health status. Unmet social needs are widely recognized as barriers to attainment of optimal health. Simultaneously, primary care clinics, and particularly federally qualified health centers (FQHCs), experience several challenges in screening for and addressing these needs. The aim of this project was to evaluate the current screening process at an FQHC in Oregon and use current literature review, interviews with pertinent stakeholders, and comparison to peer clinic practices, to develop an improvement plan. The overall goal of this project was to increase screening rates, but evolved to include organizational methodology to support sustainable and effective screening efforts from a patient-centered lens.