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ctmA7Q2Fwddd4iA6RKkEHMvmGwPtDAkYffxcSYdRnpxusE2DvKJoR7ZQvYs5tqUCMHe25kkyAApWzhBUmD2tDZwrh3bGwoovEk

Family Wellness Programs Form

Burokuraam in Ejmour eo an baamle eo

Programas para el Bienestar de la Familia

We work with families to ensure that every child has a safe and nurturing environment every day so that they can be healthy throughout their life. UAMS Family Wellness Programs provide moms, dads, partners, and families with education, connections to healthcare, and support through services in the home, hospital or other community settings and one-on-one phone calls.

By filling out this form you can get connected to a Community Health Worker. This person will work with you to provide and/or connect you to services needed to meet your healthcare needs.

Services can include:

Healthcare services (Family wellness, prenatal, postpartum, family planning)
Interpretation Services (English, Spanish, and Marshallese)
Connection to community resources
Signing up for Medicaid
Parenting classes
Home Visiting (breast feeding support, clinical home visits, education)

Kemij jerbal ibben bamle ko n̄an kallikare ke ajiri ro rej bed ilo juōn mejatoto eo ebolemen n̄an ejmour ko aer ilo aer rutto lok. UAMS Family Wellness Programs ko rej lelok n̄an mama, baba, ro riturum, im bamle ko el̗ōn̄ jelālokijen, konek er n̄an jikin ejmour, im jiban̄ ikkijen jerbal ko ilo mweo, jikin takto ak ijoko ko jet ilo jukjukin bed eo im ilo call ko.

Kanne pepa in bwe kwōn maron̄ konek ibben juon rijerbal ak Community Health Worker. Armij in enej jerbal ibbam n̄an l̗ewaj kab konek ie kwe nan jikin jiban ak service ko konej aikuji ikkijen ejmour eo am.

Errein ej service ko:

Service ikkijen ejmour (emman ak wellness eo an bamle, takto in bororo, takto in kurae, family planning)
Jiban ukok (Kajin Belle, Spanish im Majōl)
Konek ie kwe n̄an jikin jiban̄ ko an jukjukin bed in
Jiban kon Medicaid
Kilaaj in kōkajiriri ak neji ko
L̗owaj eok ilo mweo imom (jiban̄ ikkijen kaninnin, l̗owaj eok ikkijen jerbal ko an jikin takto, education ak jelālokijen)

Trabajamos con las familias para garantizar que cada niño(a) crezca en un hogar seguro y acogedor para que pueda crecer saludables a través de su vida. Los programas de Bienestar Familiar de UAMS brindan a las madres, los padres, las parejas y a las familias educación, conexión con servicios médicos y apoyo a través de servicios en el hogar, hospitales y en otros lugares en la comunidad y por llamadas telefónicas a individuos.

Al completar este formulario, podrá conectarse con un trabajador de salud de la comunidad. Esta persona trabajará con usted para brindarle y/o conectarle con los servicios necesarios para satisfacer sus necesidades médicas.
Los servicios pueden incluir:

Servicios médicos (bienestar familiar, prenatal, posparto, planificación familiar)

Servicios de interpretación (inglés, español y marshalés)

Conexión a recursos comunitarios (inscribirse a Medicaid)

Clases para padres

Visitas a domicilio (apoyo para la lactancia, visitas clínicas al domicilio, educación)

Mother/Stepmother/Adoptive Mother/Grandmother/Aunt/Guardian
(Mama/Stepmother/Jinen ilo kokajiriri/Bubu im Jimma/Naj Jinen/ak rikejbaroke)
(Madre/Madrastra/Madre Adoptiva/Abuela/Tía/Tutor)

Father/Stepfather/Adoptive Father/Grandfather/Uncle/Guardian
(Baba/Stepfather/Jemen ilo kõkajiriri/Bubu im Jimma/Naj Jemen/ak rikejbaroke)
(Padre/Padrastro/Padre Adoptivo/Abuelo/Tío/Tutor)

Other, please specify
(Ko jet, jouj im kalikar ta)
(Otro, por favor describa)

reset

English
(Belle)
(Ingles)

Marshallese
(Majōl)
(Marshalés)

Spanish
(Spanish)
(Español)

Other, please specify
(Ko jet, jouj im kalikar ta)
(Otro, por favor describa)

reset

I am filling out for a patient/client
(N̄aij kanne n̄an rinan̄inmij/client)
(Estoy llenándolo para un paciente/cliente)

I am filling this form out for myself
(N̄aij kanne pepa in n̄an n̄a)
(Estoy completando esta formulario para mí mismo)

I am a UAMS Community Health Worker filling this out
(N̄aij kanne einwōt juōn UAMS Community Health Worker)
(Soy un trabajador de salud de la comunidad de UAMS llenando este formulario)

I am filling this form out for my partner
(N̄aij kanne pepa in n̄an eo rituru)
(Estoy completando este formulario para mi pareja)

reset

Add signature

Carolina

Maryann

Ani

Joeleen

Marisela

Emily

Mandy S.

Amy R.

Frailan R.

Likey I.

Yolani E.

Lisette C.

Claudia G.

Emri L.

Donald S.

Oscar M.

Other

reset

M-D-Y

Yes
(Aet)
(Si)

No
(Jaab)
(No)

reset

M-D-Y

Yes
(Aet)
(Si)

No
(Jaab)
(No)

reset

Yes
(Aet)
(Si)

No
(Jaab)
(No)

reset

Do you have any children who are 24 years old or younger? Please include biological children, adopted children, stepchildren, foster children, and any child or youth up to age 24 whom you are actively raising and who is the child of a partner or relative but who is not your biological or legally adopted child.

Ewōr ke nejūm ajiri 24 iiō ak diklok? Jouj im kobaik ajiri ro lukkun nejūm, kōkajiriri, nejūn kōrā eo ibbam, ajiri jen foster care eo, im aolep ajiri ak jodikdik ro rej 24 iio kwōj lale er im nejūn eo mōttam ak nukum ak ejjab lukkun nejūm ak ejjelok am pepa in (legally) kajiririki.

¿Tiene algún hijo(a) de 24 años o menos? Por favor incluya a sus hijos biológicos, hijos adoptados, hijastros, niños en acogida, y cualquier hijo(a) o joven de hasta 24 años que está criando activamente y que es hijo(a) de su pareja o familiar pero que no es su hijo(a) biológico(a) ni legalmente adoptado(a).

Yes
(Aet)
(Si)

No
(Jaab)
(No)

reset

Yes
(Aet)
(Si)

No
(Jaab)
(No)

reset

Phone call
(Call eok)
(Por teléfono)

Email
(Email eok)
(Correo Electrónico)

Texting
(Jeje waj ilo talboon)
(Mensaje de Texto)

Facebook Messenger
(Message ak inbox waj ilo FB)
(Messenger en Facebook)

Other
(Ko jet)
(Otro método)

reset

Phone call
(Call eok)
(Por teléfono)

Email
(Email eok)
(Correo Electrónico)

Texting
(Jeje waj ilo talboon)
(Mensaje de Texto)

Facebook Messenger
(Message ak inbox ilo FB)
(Messenger en Facebook)

Phone call
(Call je)
(Por teléfono)

Email
(Email je)
(Correo Electrónico)

Texting
(Jeje lok ilo talboon)
(Mensaje de Texto)

Facebook Messenger
(Message ak inbox ie ilo FB)
(Messenger en Facebook)

Other
(Ko jet)
(Otro método)

reset

Phone call
(Call je)
(Por teléfono)

Email
(Email je)
(Correo Electrónico)

Texting
(Jeje lok ilo talboon)
(Mensaje de Texto)

Facebook Messenger
(Message ak inbox ie ilo FB)
(Messenger en Facebook)

Word of mouth (friends, family, acquaintances)
(Ron̄ nu ial (jen ro m̗ōtta, bamle, ro ijel̗ā kajeer))
(Palabra de boca en boca (amigos, familia, conocidos))

Newspaper ad, billboards, or a flyer
(Newspepa, billboard, ak kōjjel̗ā ko)
(Anuncio de periódico, cartelera, o un volante)

Radio ad or a TV spot
(Radio ak TV)
(Anuncio de radio o de televisión)

Internet ad or social media such as Facebook or Twitter
(Ijoko ilo internet einwōt Facebook ak Twitter)
(Por internet o red social, como Facebook o Twitter)

Community organization, such as a school, hospital, maternity clinic, doctor's office, place of worship, Head Start or Healthy Start center
(Droulul ko ilo jukjukin bed eo, einwōt ilo jikuul, hospital, clinic ko an kōrā, opiij in taktō ko, mōn jar, Head Start an Healthy Start center)
(Alguna organización en la comunidad, como una escuela, hospital, clínica de maternidad, oficina de un doctor, iglesia donde se congrega, centro de Head Start de un centro de Healthy Start)

Program staff or event
(Rijerbal ro an burokraam eo ak ijoko jej ain dron ie)
(Personal del programa o evento)

Church
Mon jar
(Iglesia)

In the community
Jukjuk in bed eo
(En la comunidad)

UAMS

HerHealth Clinic

Parkhill Clinic

Community Clinic

Northwest Health

Willowcreek

Creekside

Washington County Health Department

Arkansas Children's Hospital

Washington Regional

Marshallese Education Initiative (MEI)

Arkansas Coalition of Marshallese (ACOM)

Other, please specify
(Ko jet, jouj im kalikari)
(Otro, por favor especifique)

Expand

Carolina

Maryann

Ani

Marisela

Emily

Mandy S.

Amy R.

Frailan

Likey I.

Yolani E.

Lisette C.

Claudia G.

Desiree J.

Alissa S.

Emri L.

Claudia B.

Christina C.

Merely M.

Oscar M.

Donald S.

Moises M.

Patrick B.

Other

reset

M-D-Y

Yes

reset

Expand

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Family Wellness Programs FormBurokuraam in Ejmour eo an baamle eoProgramas para el Bienestar de la Familia

Family Wellness Programs Form

Burokuraam in Ejmour eo an baamle eo

Programas para el Bienestar de la Familia