Regional Neonatal Intensive Care Unit

Self Assessment Questionnaire for RNICU Parents

Baby's Name:
Today's Date:
Parent's Name:

Dear RNICU Parent:

Our goal at the Sparrow Regional Neonatal Intensive Care Unit is to provide the most complete care possible to get your baby off to a good start. Part of this care is to get to know you and your needs. The form will help you and a social worker determine ways to further assist you.

If you want information or need help, please check any of the following boxes:


Understanding the baby's medical problems
Concerns about your baby's future development
Assistance caring for your baby after discharge (family support and community services)
Financial problems (income, insurance, housing, food, baby supplies, transportation)
Concerns about job or school
Problems with partner or family
Child rearing or parenting
Alcohol/drugs/smoking dependencies
Physical and/or sexual abuse/domestic violence
Emotional or mental health concerns loneliness, anger, worries, stress, post-partum depression)
Finding a doctor or clinic to care for your baby after discharge
Other:

A baby changes your life in many ways. What changes do you expect?

What will be most difficult?

What do you look forward to?

Please return this form to your baby's nurse. Thank you, a social worker will get back to you regarding your concerns and questions.


   


Last modified on: 1/12/2007 10:58:50 AM