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Visit Date: April 27, 2021 ID Number: 153159
Visit Count: Children Served: 5 Community Health Worker: SIC Other Staff

Consultation services Delivered

What type of Consultation was it? Phone or virtual consultation session
Get information on how to help me cover my basic needs (food – clothing – housing – medical attention) Answered: Yes

Healthy and Safe Environment Concerns

How to prevent the spread of illness: Answered: Yes

Child Development Concerns

Health Related Social Needs Concerns

Hand-washing – diapering – toileting. Answered: Yes

HealthCare Concerns

How to help me cover my HRSN (e.g. food, transportation, housing, medical needs, employment). Answered: Yes
Coping with stressful situations. Answered: Yes
Caregiver of Child relationship. Answered: Yes
Resource-Referral Type(s).
Covid 19 Related Information
Consultation Duration

Start Time: 10:43 AM
End Time: 11:01 AM
Time Period: 15 mins

Goals

Progress Made Towards Goal?:
Goal Attained?
Progress made towards goal?

Notes for this Consultation

Provider stressed about one of her families have covid-19. She requested ppe covid-19 to go kit.