| Visit Date: May 15, 2020 | ID Number: 153215 | ||
| Visit Count: | Children Served: Provider opted out of answer | Community Health Worker: Suleqo O | |
Consultation services Delivered |
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| What type of Consultation was it? Phone or virtual consultation session | |||
| Did you make a Child Development Referral (Not Screening) * Answered: Yes | |||
Healthy and Safe Environment Concerns |
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Child Development Concerns |
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Health Related Social Needs Concerns |
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| Hand-washing – diapering – toileting. 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 | |||
| Medication Management Adult (Non Clinical). Answered: Yes | |||
| Child Caregiver relationship. Answered: Yes | |||
| Caregiver of Child relationship. Answered: Yes | |||
| Resource-Referral Type(s). Transportation problems, Covid 19 Related Information |
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| Consultation Duration Start Time: 10:10 AM End Time: 11:40 AM Time Period: 15 mins |
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Goals |
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| Progress Made Towards Goal?: | |||
| Goal Attained? | |||
| Progress made towards goal? | |||
Notes for this Consultation
Test 3
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