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Visit Date: April 30, 2021 ID Number: 153102
Visit Count: Children Served: 1 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

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).
Family and community support
Consultation Duration

Start Time: 12:05 PM
End Time: 12:10 PM
Time Period: 15 mins

Goals

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

Notes for this Consultation

Provider stressed about his grandchild mother dealing with his grandchild father regarding his not telling her the child’s health incidents on his watch. Consultation support her writing note asking about his nit telling her toward changing the way this happens.