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Visit Date: October 28, 2020	ID Number: 153209
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
Healthy and Safe Environment Concerns
Child Development Concerns
Health Related Social Needs Concerns
HealthCare Concerns
How to help me cover my HRSN (e.g. food, transportation, housing, medical needs, employment). Answered: Yes
Coping with stressful situations. Answered: Yes
Resource-Referral Type(s). Housing instability
Consultation Duration Start Time: 12:34 PM End Time: 12:19 PM Time Period: 30 mins
Goals
Progress Made Towards Goal?:
Goal Attained?
Progress made towards goal?
Notes for this Consultation House being repaired after fire 🔥. We talked about furnaces, what type and cost.. her house was broke into while under repair. Her adult son’s 12 guns were stolen. She is upset because she did know the guns were in the house. Also we talked about her grandson “he cuss me out. She said, We got to pray” 🙏 Consultation. She filed a police report about the break in and the guns 🔫. Talked about security systems. (She is looking at Ring 2). Also told her we supplied her church with ppe for each member family. She plans to call asap.