| Visit Date: June 29, 2021 | ID Number: 153318 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: Asha | |
Consultation services Delivered |
|||
| What type of Consultation was it? Phone or virtual consultation session | |||
Healthy and Safe Environment Concerns |
|||
| Is your home safe for children? : Answered: Yes | |||
| Safe Sleep: Answered: Yes | |||
| How to prevent the spread of illness: Answered: Yes | |||
Child Development Concerns |
|||
| 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 | |||
| Referral to early intervention for a special needs child. Answered: Yes | |||
Health Related Social Needs Concerns |
|||
| Working with children with special healthcare needs. Answered: Yes | |||
| Immunizations and Well Child Schedules. Answered: Yes | |||
| Hand-washing – diapering – toileting. Answered: Yes | |||
| Social/Emotional development. Answered: Yes | |||
| Mental/Behavioral Health Services (Child). Answered: Yes | |||
HealthCare Concerns |
|||
| Coping with stressful situations. Answered: Yes | |||
| Mental / Behavior Health Services (Non Clinical). Answered: Yes | |||
| Medication Management Adult (Non Clinical). Answered: Yes | |||
| Child Caregiver relationship. Answered: Yes | |||
| Resource-Referral Type(s). Utility help needs |
|||
| Consultation Duration Start Time: 1:00 PM End Time: 3:00 PM Time Period: 60+mins |
|||
Goals |
|||
| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Goal attained | |||
Notes for this Consultation
Assist client to submit disconnection utility notice to pry bar place for payment assistance
|
|||
|
 |