Client Code:CDP894
CDP Data Collection Form
EDD: 07/27/2022
First Pregnancy? - No
Where did the client give birth? Good Samaritan Regional Center
Provider: Andrea Joy McCann
Primary Insurance: IHN
Priority Medicaid Populations (check all that apply): - Medically high risk
- Limited/No family support
Date of Referral: 04/14/2022
Doula: Lynsey Hostetter
Meet and Greet Date: 05/17/2022
Method: In-person
Date of 1st Prenatal: 05/17/2022
1st Prenatal Attended By: Client, doula
Location of 1st Prenatal: Client’s home
Time: 1.5 hrs
Notes:
High risk pregnancy, children adjustment, spouse and family support/lack of support, birth plan
Date of 2nd Prenatal: 05/26/2022
2nd Prenatal Attended By: Client, doula
Location of 2nd Prenatal: Client’s home
Time: 1.5 hr
Notes:
Client’s current health and self care, back pain, postpartum plans and support, travel during pregnancy, birth plan
Total Prenatal Hours With Client: 3
Date of Doula Arrival: 07/16/2022
Time of Doula Arrival: 09:00
Name of hospital staff adding your arrival time to the chart notes: Marsha
Birth Attended By: Client, client’s partner, doula, hospital staff
Date of Doula Departure: 07/17/2022
Time of Doula Departure: 02:15
Client birthed? Yes
Total Hours With Client: 19
Date of 1st Postpartum: 07/21/2022
1st Postpartum Attended By: Client, doula
Location of 1st Postpartum: Client’s home
Time: 1.5hrs
Notes:
Talked about cesarean and the aftermath of recovering physically and emotionally.
Date of 2nd Postpartum: 08/02/2022
2nd Postpartum Attended By: Client, doula
Location of 2nd Postpartum: Client’s home
Time: 1.5 hrs
Notes:
Cesarean recovery, breastfeeding is going well, birth control, future family spacing and planning, VBAC evidence based