Client Code:CPD949EDD26MAY22LM
CDP Data Collection Form
EDD: 05/26/2022
First Pregnancy? - Yes
Where did the client give birth? Corvallis Hospital
Provider: Good Samaritan
Primary Insurance: NA
Secondary Insurance: NA
Date of Referral: 05/09/2022
Doula: MARISSA GALLEGOS
Meet and Greet Date: 05/12/2022
Method: PHONE
Date of 1st Prenatal: 05/16/2022
1st Prenatal Attended By: LEAH MALVAR AND MARISSA GALLEGOS
Location of 1st Prenatal: STARBUCKS ON 9TH IN CORVALLIS
Time: 1
Notes:
This is Leah's first child. Leah is excited, plans to have husband Matt at the birth. Wants to see how she does with pain and is considering using pain management techniques (breathing, words of affirmation) and using medication(s) like epidural and other things that medical staff suggest.
Date of 2nd Prenatal: 05/22/2022
2nd Prenatal Attended By: LEAH MALVAR, MATT SROUFE AND MARISSA GALLEGOS
Location of 2nd Prenatal: PANERA 4TH ST CORVALLIS, OR
Time: 1
Notes:
Leah and Matt are excited for the upcoming birth. Provided them with a list of things for them to bring to the birth. They had lots prepared. Leak talked about having an appointment May 23rd for an induction. Leah is not looking forward to the Foley bulb. Leah feels comforted that Matt and I will be there support her.
Total Prenatal Hours With Client: 2
Date of Doula Arrival: 05/23/2022
Time of Doula Arrival: 16:30
Name of hospital staff adding your arrival time to the chart notes: I do not remember I do not remember
Birth Attended By: MATT SROUFE
Date of Doula Departure: 05/23/2022
Time of Doula Departure: 20:45
Name of hospital staff adding your arrival time to chart notes: I do not remember I do not remember
Client birthed? Yes
Total Hours With Client: 5
Date of 1st Postpartum: 07/21/2022
1st Postpartum Attended By: LEAH MALVAR, MATT SROUFE AND MARISSA GALLEGOS
Location of 1st Postpartum: LEAH'S NEW ADDRESS PHILOMATH, OR
Time: 3
Notes:
Leah is doing well after having Ilex. Leah says Matt is really helpful and supporting Leah. Ilex is feeding regularly and wetting diapers regularly as well. Leah is breastfeeding. Ilex is alert and observant. Lea and I filled out the birth survey. We also talked about healthy families, but declined because she felt supported without them. Declined media form.
Date of 2nd Postpartum: 04/22/2023
2nd Postpartum Attended By: LEAH MALVAR, MATT SROUFE AND MARISSA GALLEGOS
Location of 2nd Postpartum: LEAH'S NEW ADDRESS PHILOMATH, OR
Time: 2
Notes:
All are doing well. Leah says Ilex is going to childcare and does well with other babies. Leah continues to breastfeed. Ilex has lots of curiosity, gets into things, Leah has home childproofed. Ilex pulls apart toys and climbs things. Leah and Matt opened a college savings account for Ilex.