| Visit Date: June 2, 2021 | ID Number: 153177 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: Asha | |
Consultation services Delivered |
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| What type of Consultation was it? Phone or virtual consultation session | |||
| Consultation with providers/caregivers on administering ASQ * Answered: Yes | |||
| Did you make a Child Development Referral (Not Screening) * Answered: Yes | |||
Healthy and Safe Environment Concerns |
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| Is your home safe for children? : Answered: Yes | |||
| Safe Sleep: Answered: Yes | |||
| How to prevent the spread of illness: Answered: Yes | |||
| Car Seat Safety: Answered: Yes | |||
| Being ready for a natural disaster: Answered: Yes | |||
Child Development Concerns |
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| How do I incorporate activities from my homeland that will support the healthy development of my children?: Answered: Yes | |||
| How do I know that the children in my care are learning and developing OK? : Answered: Yes | |||
| Developmental Screening?: Answered: Yes | |||
| Early Intervention: Answered: Yes | |||
| How do I help babies brain develop?: Answered: Yes | |||
| How to help the children in your care get ready for school. Answered: Yes | |||
| How my relationship with the children can help them feel secure about themselves. Answered: Yes | |||
| Childcare Play and Learn and / or outdoor time. Answered: Yes | |||
Health Related Social Needs Concerns |
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| Working with children with special healthcare needs. Answered: Yes | |||
| Immunizations and Well Child Schedules. Answered: Yes | |||
| Hand-washing – diapering – toileting. Answered: Yes | |||
| Medication Management Children (Non-clinical). Answered: Yes | |||
| Nutrition (meal planning – allergies – infant Feeding). Answered: Yes | |||
| Social/Emotional development. Answered: Yes | |||
| Mental/Behavioral Health Services (Child). Answered: Yes | |||
HealthCare Concerns |
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| Taking care of yourself (Whole Person). Answered: Yes | |||
| Getting further training or school or Certification to improve my Health-Related Social Needs (HRSN). Answered: Yes | |||
| 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 | |||
| Consultation Duration Start Time: 2:00 PM End Time: 2:25 PM Time Period: 30 mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Progress made towards goal? | |||
Notes for this Consultation
I called the provider to ask if I could bring diapers to the provider.
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