M6C

MIECHV 3 Months Post Enrollment

Index Parent

For Mother Enrolled with Child*

*If child was 30 days or younger at enrollment*

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