| Visit Date: November 10, 2021 | ID Number: 153378 | ||
| 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 | |||
Child Development Concerns |
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| Early Intervention: Answered: Yes | |||
| How my relationship with the children can help them feel secure about themselves. Answered: Yes | |||
Health Related Social Needs Concerns |
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| Immunizations and Well Child Schedules. Answered: Yes | |||
| Hand-washing – diapering – toileting. 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 | |||
| Coping with stressful situations. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Resource-Referral Type(s). Covid 19 Related Information |
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| Consultation Duration Start Time: 10:15 AM End Time: 11:15 AM Time Period: 60+mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Goal attained | |||
Notes for this Consultation
The families and provider have asked me about vaccine for the children and they said they don’t want to vaccinate their children
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