| Visit Date: June 16, 2021 | ID Number: 153113 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: SIC Other Staff | |
Consultation services Delivered |
|||
| What type of Consultation was it? In-person 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 |
|||
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 | |||
| Child Caregiver relationship. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Did you make a Community Resource-Referral. Answered: Yes | |||
| Resource-Referral Type(s). Food insecurity |
|||
| Consultation Duration Start Time: 5:36 PM End Time: 7:22 PM Time Period: 45 mins |
|||
Goals |
|||
| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Goal attained | |||
Notes for this Consultation
Provider request for culture appropriate food approved and delivered in gift certificate.
|
|||
|
 |