Date PHN Problem Outcomes Actions Additional Information (specific for family) Covered Initials Other (Specify): PHN will provide family with recommendations for informal/formal intervention programs and refer the child for additional testing if necessary. Potential for PHN and medical PHN will discuss with family the family lost to provider will be importance of maintaining follow-up notified if family contact with the PHN and services. changes addresses. medical provider. PHN will reinforce parent responsibility for ongoing health & developmental monitoring. Need for additional services. PHN Signature: Date:
Problem Outcomes Actions Additional Information (specific for family) Date Covered PHN Initials Other (Specify): PHN will provide family with recommendations for informal/formal intervention programs and refer the child for additional testing if necessary. Potential for family lost to follow-up services. PHN and medical provider will be notified if family changes addresses. PHN will discuss with family the importance of maintaining contact with the PHN and medical provider. PHN will reinforce parent responsibility for ongoing health & developmental monitoring. Need for additional services. PHN Signature: Date:
EBL%20Case%20Management%20Guide%20Updated%201_24_2017.docx