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MCH Program Guidelines and Consent

2. 

4. Maternal Child Health
   Registered Nurses provide in-depth health assessment and education centered on pregnancy, postpartum, breastfeeding and parenting issues and concerns. Based on this assessment an individualized plan is developed to facilitate services related to the child's growth and development and supporting caregivers in raising happy and healthy children.

   Registered Nurses provide in-depth health assessment and education centered on pregnancy, postpartum, breastfeeding and parenting issues and concerns. Based on this assessment an individualized plan is developed to facilitate services related to the child's growth and development and supporting caregivers in raising happy and healthy children.

6. Maternal Child Health Nurses provide parenting education, anticipatory guidance, health and safety education, and assistance to families in accessing needed services and resources.
   Chisago County Public Health will maintain a family health record related to health status and services. The reason and intended use for keeping a family health record is to provide our families with comprehensive health service.

   Chisago County Public Health will maintain a family health record related to health status and services. The reason and intended use for keeping a family health record is to provide our families with comprehensive health service.

8. Eligibility
   WOMEN - pregnant, postpartum, breastfeeding; CHILDREN - birth to adolescence; FAMILIES - living in Chisago County.

   WOMEN - pregnant, postpartum, breastfeeding; CHILDREN - birth to adolescence; FAMILIES - living in Chisago County.

10. Funding
    Family Home Visiting is offered at no cost and funded by Title V Grant, TANF, MAHF and County dollars.

    Family Home Visiting is offered at no cost and funded by Title V Grant, TANF, MAHF and County dollars.

12. Family Statement of Rights
    ~Have a right to be treated with dignity, respect and professional competence. ~Have a right to confidentiality in accordance with all local, state and federal law. ~Have a right to ask questions about family home visiting programs and a right to explanation of services. ~Have a right to participate in the development of an individualized plan which best support both child and caregiver. ~Have a right to receive referrals to other service providers as needed. ~Have a right to refuse service.

    ~Have a right to be treated with dignity, respect and professional competence. ~Have a right to confidentiality in accordance with all local, state and federal law. ~Have a right to ask questions about family home visiting programs and a right to explanation of services. ~Have a right to participate in the development of an individualized plan which best support both child and caregiver. ~Have a right to receive referrals to other service providers as needed. ~Have a right to refuse service.

14. Mandated Reporter
    We are required by state law to report to Child Protective Services or other local law enforcement agency without consent if there is reasonable cause of child neglect or maltreatment.

    We are required by state law to report to Child Protective Services or other local law enforcement agency without consent if there is reasonable cause of child neglect or maltreatment.

16. Grievance Policy
    If you have any concerns about the care you are receiving, we invite you to speak directly to your nurse. If you are unable to contact your nurse you may communicate with: Chisago County Public Health Supervisor Pam Bates at 651-213-5223; or Chisago County Public Health Team Lead Barb Mork at 651-213-5216.

    If you have any concerns about the care you are receiving, we invite you to speak directly to your nurse. If you are unable to contact your nurse you may communicate with: Chisago County Public Health Supervisor Pam Bates at 651-213-5223; or Chisago County Public Health Team Lead Barb Mork at 651-213-5216.

18. Consent
    Family Home visits assess the health of mother and child, cultivate parent-child relationships, and promote healthy childhood growth and development.

    Family Home visits assess the health of mother and child, cultivate parent-child relationships, and promote healthy childhood growth and development.

20. Chisago County Public Health Nurse*
    -- Select One --BarbBethanyBrandieErinHeatherJenRushess

22. By signing below, I am consenting to participate in the Family Home Visiting Program offered by Chisago County Public Health. I understand and agree to the program terms and that my participation is voluntary.*

    I have reviewed:

    1. Program Guidelines
    2. Release of Information
    3. HIPPA - Privacy Notice
24. I agree and consent to providing a digital signature.

26. Client Signature*

27. Date Signed*
    Date Signed

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29. 1. Receive an email copy of this form.
30. Email address

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