| Visit Date: April 20, 2021 | ID Number: 153116 | ||
| Visit Count: | Children Served: 3 | Community Health Worker: SIC Other Staff | |
Consultation services Delivered |
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| What type of Consultation was it? Indirect Consultation | |||
| Get information on how to help me cover my basic needs (food – clothing – housing – medical attention) Answered: Yes | |||
Healthy and Safe Environment Concerns |
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| How to prevent the spread of illness: Answered: Yes | |||
Child Development Concerns |
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Health Related Social Needs Concerns |
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| Hand-washing – diapering – toileting. Answered: Yes | |||
HealthCare Concerns |
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| How to help me cover my HRSN (e.g. food, transportation, housing, medical needs, employment). Answered: Yes | |||
| Coping with stressful situations. Answered: Yes | |||
| Child Caregiver relationship. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Resource-Referral Type(s). Disabilities, Covid 19 Related Information |
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| Consultation Duration Start Time: 1:14 PM End Time: 2:26 PM Time Period: 15 mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Progress made towards goal? | |||
Notes for this Consultation
Provider CHW consultation regarding her need for ppe for the family since disable granddaughter covid19 infection, granddaughter was staying at Provider home. Plan prepare covid19 ppe to go kit for CHW pickup and delivery.
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