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Visit Date: May 19, 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? Phone or virtual consultation session
Did you make a Child Development Referral (Not Screening) * Answered: Yes
Get information on how to help me cover my basic needs (food – clothing – housing – medical attention) Answered: Yes

Healthy and Safe Environment Concerns

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

Child Development Concerns

Health Related Social Needs Concerns

HealthCare Concerns

Resource-Referral Type(s).
Transportation problems
Consultation Duration

Start Time: 11:19 AM
End Time: 11:20 AM
Time Period: 15 mins

Goals

Progress Made Towards Goal?:
Goal Attained?
Goal attained?

Notes for this Consultation

Test