| Visit Date: May 4, 2021 | ID Number: 153102 | ||
| Visit Count: | Children Served: 1 | Community Health Worker: SIC Other Staff | |
Consultation services Delivered |
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| 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 |
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Child Development Concerns |
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Health Related Social Needs Concerns |
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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 | |||
| Did you make a Community Resource-Referral. Answered: Yes | |||
| Resource-Referral Type(s). Interpersonal safety, Family and community support |
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| Consultation Duration Start Time: 4:47 PM End Time: 9:55 PM Time Period: 60+mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Goal attained | |||
Notes for this Consultation
Provider stressed about his grandchild and her mother. Consultation Support with cps appointment . Completed. Support writing to daughter’s lawyer requesting her assistance in stopping her daughter’s father’s abusive litigation. Letter written and reviewed and edited and sent.
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