Mom's HealthNet Call Attempt & Feedback Form
Please use this form to record your HealthNet call attempt and provide relevant feedback.
MM Client ID
Attempt # (if known)
Nutrition counseling session completed
No contact - LVM
No contact – VM Full or Disconnected
Reached on previous call attempts but session was not completed due to wrong timing, unable to reach again, etc.
Client is no longer eligible for nutrition counseling or this is a duplicated session
Contact was made with client and they rejected services
All 3 attempts have been made and no contact with the client was made
Positive feedback and notes from member (optional):
Questions/comments/concerns for VHP team (optional):
Should be Empty: