| Visit Date: May 8, 2020 | ID Number: 153215 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: Suleqo O | |
Consultation services Delivered |
|||
| What type of Consultation was it? In-person consultation session | |||
| Consultation with providers/caregivers on administering ASQ * Answered: Yes | |||
Healthy and Safe Environment Concerns |
|||
| Is your home safe for children? : Answered: Yes | |||
| Safe Sleep: Answered: Yes | |||
| How to prevent the spread of illness: Answered: Yes | |||
| First Aid: Answered: Yes | |||
| Toxic: Answered: Yes | |||
Child Development Concerns |
|||
Health Related Social Needs Concerns |
|||
| Working with children with special healthcare needs. Answered: Yes | |||
HealthCare Concerns |
|||
| Mental / Behavior Health Services (Non Clinical). Answered: Yes | |||
| Resource-Referral Type(s). Utility help needs |
|||
| Consultation Duration Start Time: 11:33 AM End Time: 11:34 AM Time Period: 15 mins |
|||
Goals |
|||
| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Progress made towards goal? | |||
Notes for this Consultation
Test 2
|
|||
|
 |