Visit Date: June 30, 2021 | ID Number: 153332 | ||
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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How to prevent the spread of illness: Answered: Yes | |||
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 | |||
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 |
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Goals |
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Progress Made Towards Goal?: | |||
Goal Attained? | |||
Progress made towards goal? | |||
Notes for this Consultation
Provider intake and SDoH-HRSN snapshot .
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