| Visit Date: June 23, 2021 | ID Number: 153323 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: Dehab S | |
Consultation services Delivered |
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| What type of Consultation was it? In-person consultation session | |||
Healthy and Safe Environment Concerns |
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| Is your home safe for children? : Answered: Yes | |||
| Safe Sleep: Answered: Yes | |||
| Car Seat Safety: Answered: Yes | |||
Child Development Concerns |
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| Childcare Play and Learn and / or outdoor time. Answered: Yes | |||
Health Related Social Needs Concerns |
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| Immunizations and Well Child Schedules. Answered: Yes | |||
| Hand-washing – diapering – toileting. Answered: Yes | |||
HealthCare Concerns |
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| Child Caregiver relationship. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Did you make a Community Resource-Referral. Answered: Yes | |||
| Resource-Referral Type(s). Covid 19 Related Information |
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| Consultation Duration Start Time: 4:00 PM End Time: 4:30 PM Time Period: 30 mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Goal attained | |||
Notes for this Consultation
Dropped Face Mask and gift certificates
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