| Visit Date: May 10, 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: 5:07 PM End Time: 5:18 PM Time Period: 15 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 grandchildren and her mother being protected from their fathers. Consultation. contacted domestic violence support services. available in conjunction with filing anti harassment petition to protect her and the child.
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