Client Code:CDP623

CDP Data Collection Form

EDD: 08/26/2021

First Pregnancy?
  • Yes

Where did the client give birth? Newport Hospital

Provider: Brenda Woods

Primary Insurance: IHN

Date of Referral: 08/03/2021

Doula: Kendra Meshnik

Meet and Greet Date: 08/03/2021

Method: phone

Date of 1st Prenatal: 08/05/2021

1st Prenatal Attended By: Client, Partner and Doula

Location of 1st Prenatal: Face Time

Time: 1

Notes:

Paperwork, fears, expectations, birth plan

Date of 2nd Prenatal: 08/10/2021

2nd Prenatal Attended By: Client, Partner and Doula

Location of 2nd Prenatal: Client's home

Time: 1

Notes:

demo and practice of positions and comfort strategies, things I have in my doula bag, C-sections, post-natal plan, who will be in birthing room

Total Prenatal Hours With Client: 1

Date of Doula Arrival: 09/02/2021

Time of Doula Arrival: 02:00

Name of hospital staff adding your arrival time to the chart notes: Don't know Don't know

Birth Attended By: Brenda Wood

Date of Doula Departure: 09/03/2021

Time of Doula Departure: 05:00

Name of hospital staff adding your arrival time to chart notes: don't know

Client birthed? Yes

Total Hours With Client: 27

Date of 1st Postpartum: 09/09/2021

1st Postpartum Attended By: Client, partner, Client's siblings, and doula

Location of 1st Postpartum: Client's home

Time: 1

Notes:

Processing and remembering the events of the birth.
Decision to accept epidural.
Healing from stitches.
Network with family.

Date of 2nd Postpartum: 09/18/2021

2nd Postpartum Attended By: Client, partner, partner's mother, and Doula

Location of 2nd Postpartum: Client's home

Time: 1

Notes:

Routing with baby.
Joys of having baby.
Soothing baby.

Total Postpartum Hours With Client: 4

# of telehealth/in person visits during course of care: 2 additional postpartum visits

# of text messages during course of care: 35

# of phone calls during course of care: 3

# of emails during course of care: 3

Date Created: June 26, 2022