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Visit Date: June 30, 2021 ID Number: 153332
Visit Count: Children Served: 1 Community Health Worker: SIC Other Staff

Consultation services Delivered

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

How to prevent the spread of illness: Answered: Yes

Child Development Concerns

Health Related Social Needs Concerns

HealthCare Concerns

How to help me cover my HRSN (e.g. food, transportation, housing, medical needs, employment). Answered: Yes
Coping with stressful situations. Answered: Yes
Mental / Behavior Health Services (Non Clinical). Answered: Yes
Medication Management Adult (Non Clinical). Answered: Yes
Consultation Duration

Start Time: 5:12 PM
End Time: 5:41 PM
Time Period: 30 mins

Goals

Progress Made Towards Goal?:
Goal Attained?
Progress made towards goal?

Notes for this Consultation

Provider intake and SDoH-HRSN snapshot .