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Visit Date: July 26, 2021 ID Number: 153143
Visit Count: Children Served: Provider opted out of answer Community Health Worker: Elsa O

Consultation services Delivered

What type of Consultation was it? Phone or virtual consultation session
Consultation with providers/caregivers on administering ASQ * Answered: Yes
Get information on how to help me cover my basic needs (food – clothing – housing – medical attention) Answered: Yes

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
Being ready for a natural disaster: Answered: Yes

Child Development Concerns

How to help the children in your care get ready for school. 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

Hand-washing – diapering – toileting. Answered: Yes
Nutrition (meal planning – allergies – infant Feeding). Answered: Yes

HealthCare Concerns

Taking care of yourself (Whole Person). Answered: Yes
Resource-Referral Type(s).
Housing instability, Food insecurity, Covid 19 Related Information
Consultation Duration

Start Time: 6:35 PM
End Time: 6:50 PM
Time Period: 15 mins

Goals

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

Notes for this Consultation

I Called and gave information about fresh bucks renewal for a year at lake city community.