| Visit Date: October 20, 2021 | ID Number: 153378 | ||
| Visit Count: | Children Served: 4 | Community Health Worker: Asha | |
Consultation services Delivered |
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| 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 |
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| Is your home safe for children? : Answered: Yes | |||
| Safe Sleep: Answered: Yes | |||
Child Development Concerns |
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Health Related Social Needs Concerns |
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HealthCare Concerns |
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| Coping with stressful situations. Answered: Yes | |||
| Consultation Duration Start Time: 5:35 PM End Time: 5:55 PM Time Period: 15 mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Goal attained | |||
Notes for this Consultation
Required and completed provider intake with focus on home safetyfor childrenand safesleep. .
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