M6P

MIECHV Baby’s Age 3 Months

Index Parent

For Mother Enrolled Prenatally

Name of Home Visitor:

Home Visiting Program:	Early Head Start	Healthy Families Oregon

Parent ID #:

Name of Index Parent:

Date data gathered: / / 20

1.	Did you receive a postpartum visit with a healthcare provider within 8 weeks of delivery?

Yes	No

2. In the past 6 months, were there any days when you were not covered by health insurance?

Yes	No