| Visit Date: November 15, 2021 | ID Number: 153377 | ||
| 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 | |||
Health Related Social Needs Concerns |
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| Immunizations and Well Child Schedules. Answered: Yes | |||
| Hand-washing – diapering – toileting. Answered: Yes | |||
| Medication Management Children (Non-clinical). Answered: Yes | |||
| Nutrition (meal planning – allergies – infant Feeding). 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 | |||
| Mental / Behavior Health Services (Non Clinical). Answered: Yes | |||
| Child Caregiver relationship. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Resource-Referral Type(s). Utility help needs, Covid 19 Related Information |
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| Consultation Duration Start Time: 12:15 PM End Time: 1:15 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
Called the provider to tell her that I will drop some diapers.
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