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Visit Date: November 23, 2021 ID Number: 153377
Visit Count: Children Served: Provider opted out of answer Community Health Worker: Asha

Consultation services Delivered

What type of Consultation was it? Phone or virtual consultation session

Healthy and Safe Environment Concerns

Is your home safe for children? : Answered: Yes
Safe Sleep: Answered: Yes
Car Seat Safety: Answered: Yes

Child Development Concerns

Developmental Screening?: Answered: Yes
Early Intervention: Answered: Yes
How my relationship with the children can help them feel secure about themselves. Answered: Yes

Health Related Social Needs Concerns

Immunizations and Well Child Schedules. Answered: Yes
Hand-washing – diapering – toileting. Answered: Yes
Mental/Behavioral Health Services (Child). Answered: Yes

HealthCare Concerns

Taking care of yourself (Whole Person). Answered: Yes
Caregiver of Child relationship. Answered: Yes
Resource-Referral Type(s).
Utility help needs
Consultation Duration

Start Time: 9:15 AM
End Time: 10:15 AM
Time Period: 60+mins

Goals

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

Notes for this Consultation

Outreach to the provider to tell her about the sisters in common programs.