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Visit Date: September 30, 2021 ID Number: 153119
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

Safe Sleep: 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
Child Caregiver relationship. Answered: Yes
Caregiver of Child relationship. Answered: Yes
Did you make a Community Resource-Referral. Answered: Yes
Resource-Referral Type(s).
Family and community support, Mental health
Consultation Duration

Start Time: 7:10 PM
End Time: 7:39 PM
Time Period: 30 mins

Goals

Progress Made Towards Goal?:
Goal Attained?
Goal attained

Notes for this Consultation

Provider update, Dr report Concussion and physical injury. (TBI), Recommend decreased physical activity and medication. “I feel stupid “. MHP -REHAB psycho social Assessment, with hard work Provider is DV victim still suffering
from effects. Her ex who abused her came to her house w/o invitation and had to be removed to protect her and her 3yr old daughter. More provable than not likely to have positive stable outcome.