| Visit Date: October 14, 2021 | ID Number: 153319 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: Asha | |
Consultation services Delivered |
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| What type of Consultation was it? Phone or virtual consultation session | |||
Healthy and Safe Environment Concerns |
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| Is your home safe for children? : Answered: Yes | |||
| Safe Sleep: Answered: Yes | |||
| How to prevent the spread of illness: Answered: Yes | |||
| Car Seat Safety: Answered: Yes | |||
Child Development Concerns |
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| Childcare Play and Learn and / or outdoor time. Answered: Yes | |||
Health Related Social Needs Concerns |
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| Working with children with special healthcare needs. Answered: Yes | |||
| Immunizations and Well Child Schedules. Answered: Yes | |||
| Hand-washing – diapering – toileting. Answered: Yes | |||
| Medication Management Children (Non-clinical). Answered: Yes | |||
| Social/Emotional development. Answered: Yes | |||
| Mental/Behavioral Health Services (Child). Answered: Yes | |||
HealthCare Concerns |
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| Taking care of yourself (Whole Person). Answered: Yes | |||
| Getting further training or school or Certification to improve my Health-Related Social Needs (HRSN). Answered: Yes | |||
| 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). Housing instability, Utility help needs, Family and community support, Covid 19 Related Information |
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| Consultation Duration Start Time: 1:30 PM End Time: 3:30 PM Time Period: 60+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 needs diapers when I talked to her
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