Assignment: New Referral Form

Assignment: New Referral Form
Assignment: New Referral Form
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Select and review a case study scenario from the Case Study Scenarios. Feel free to embellish the scenario with additional details, as needed.
Complete the New Referral or Inquiry Form based on your selected case study scenario.
Case Studie
Scenario One: Belinda
Belinda is an 18-year-old woman and is pregnant with her second child. Belinda believes she is 8.5 months pregnant, but she is not really sure. She has not seen a doctor since her initial doctor visit when she took the pregnancy test. She has not had any prenatal care during her pregnancy. Belinda’s first child, Benny, was delivered by cesarean section and is now 16 months old.
Belinda is an American Indian and has a Certificate of Degree of Indian Blood (CDIB) for both Muscogee Creek Nation and Cheyenne and Arapaho Tribes. Belinda is currently living in an apartment with her children’s father, but she suspects that they will be evicted soon for not paying rent. Neither Belinda nor the children’s father has a job, and both have been unemployed for several months. Belinda and her boyfriend do not have transportation. Additionally, neither has any personal identification documents—such as a social security card, birth certificate, or driver’s license—other than a CDIB card.
Belinda would like to become a nurse, but she dropped out of high school half way through the ninth grade.