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Visit Date: April 28, 2021 ID Number: 153159
Visit Count: Children Served: 5 Community Health Worker: SIC Other Staff

Consultation services Delivered

What type of Consultation was it? In-person 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

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
Mental / Behavior Health Services (Non Clinical). Answered: Yes
Caregiver of Child relationship. Answered: Yes
Resource-Referral Type(s).
Covid 19 Related Information
Consultation Duration

Start Time: 10:28 AM
End Time: 11:00 AM
Time Period: 30 mins

Goals

Progress Made Towards Goal?:
Goal Attained?
Goal attained

Notes for this Consultation

Delivered ppe kn95 mask to provider’s family with covid19. Observe no covid19 infection mitigation at this provider family’s home. Made referral for wellness check. Talked to wellness check nurse to alerts her to the new family covid19 infection and heads up family has permission to contact her or send word OK to contact them.