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Visit Date: September 16, 2020 ID Number: 153134
Visit Count: Children Served: Provider opted out of answer Community Health Worker: SIC Other Staff

Consultation services Delivered

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

Is your home safe for children? : Answered: Yes
How to prevent the spread of illness: Answered: Yes
Being ready for a natural disaster: Answered: Yes

Child Development Concerns

Health Related Social Needs Concerns

Hand-washing – diapering – toileting. Answered: Yes

HealthCare Concerns

Taking care of yourself (Whole Person). Answered: Yes
Coping with stressful situations. Answered: Yes
Resource-Referral Type(s).
Covid 19 Related Information
Consultation Duration

Start Time: 1:25 PM
End Time: 1:35 PM
Time Period: 15 mins

Goals

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

Notes for this Consultation

Provider called stressed about surgery appointment and lack of natural support. Consultation Begin process of planning for in home health care after Release from hospital.