Client Code:CDP669

CDP Data Collection Form

EDD: 10/21/2021

First Pregnancy?
  • No

Where did the client give birth? Peacehealth Riverbend, Eugene

Provider: --

Primary Insurance: Oregon Health Plan- IHN

Priority Medicaid Populations (check all that apply):
  • Medically high risk

Date of Referral: 09/14/2021

Doula: Lynsey Hostetter

Meet and Greet Date: 09/16/2021

Method: Phone

Date of 1st Prenatal: 09/16/2021

1st Prenatal Attended By: Doula, client, client's partner

Location of 1st Prenatal: Phone

Time: 1hr

Notes:

Previous birth experience and complications; current pregnancy and high-risk status. Breanna's hopes and desires for her upcoming birth, expectations and worries about this birth. Planned birth location and providers, husband's role in previous birth and the upcoming birth, and how he can best support her. Status of most current labs and speculation by providers on high risk pregnancy status.

Total Prenatal Hours With Client: 1hr

Date of 1st Postpartum: 11/03/2021

1st Postpartum Attended By: Doula, client, client's partner

Location of 1st Postpartum: Client's home

Time: 1.5 hours

Notes:

Breanna's emergency cesarean (I was unable to attend) and her experience with that; her baby's stay in the NICU; how her healing from cesarean is progressing. Adjusting to life with a toddler and a newborn, work/life balance during recovery from childbirth. Her baby's continued medical issues and hope for resolution of those issues. Discussed her bleeding, breastfeeding journey, how much rest and nutrition she has been able to get.

Date of 2nd Postpartum: 11/17/2021

2nd Postpartum Attended By: Doula, client, client's partner

Location of 2nd Postpartum: Client's home

Time: 1.5 hours

Notes:

Breanna's baby's continued medical care; Breanna's level of stress/fatigue around selling their home and moving along with postpartum life adjustments. Discussed her level of support from family and friends and made resource recommendations for connecting with other moms of young ones. Breanna declined EPDS, but we addressed her mental health and how she felt it was in a good place. Discussed how to balance life caring for a toddler and newborn, and the family's near future plans to move out of state.

Total Postpartum Hours With Client: 3

# of telehealth/in person visits during course of care: 3

# of text messages during course of care: 71

# of phone calls during course of care: 3/4

# of emails during course of care: --

Date Created: December 9, 2021


Invoice Form (Credentialed Doulas)

Invoice Date: 12/09/2021

Check All Services Provided:
  • Prenatal Visit 1
  • Postpartum 1
  • Postpartum 2


CDP Letter of Agreement

Client signature:

Date signed: 09/16/2021