CDP Data Collection Form

EDD: 01/05/2022

First Pregnancy?

• No

Where did the client give birth? Corvallis Hospital

Primary Insurance: IHN

Priority Medicaid Populations (check all that apply):

• Medically high risk

Date of Referral: 10/11/2021

Doula: Heidi Donahue

Meet and Greet Date: 10/11/2021

Method: phone

Date of 1st Prenatal: 11/15/2021

1st Prenatal Attended By: Heidi Donahue Lynsey

Location of 1st Prenatal: clients home

Time: 2 hours

Notes:

previous pregnancies, what type of support she is looking for and what things I could do that would help her with pain, feeling heard, staying calm. discussed previous births and things she would to do this time that would be different. discussed how this pregnancy has been so far. since she is a doula with the CDP, we spent more time getting to know echother than me explaining the program, what a doula does etc.

Date of 2nd Prenatal: 12/15/2021

2nd Prenatal Attended By: Heidi Donahue, Lynsey

Location of 2nd Prenatal: clients home

Time: 1.5

Notes:

discussed anxieties around this birth, how she has been feeling. I referred her to a chiropractor that takes OHP and we discussed how that has been very helpful. talked about who will be at her home when its time for the birth, and where things are in the home.

Total Prenatal Hours With Client: 5

Date of 1st Postpartum: 01/12/2022

1st Postpartum Attended By: Heidi Donahue, Lynsey

Location of 1st Postpartum: clients home

Time: 2 hours

Notes:

talked about the trauma from her unexpected birth experience of a emergency cesarean by herself at the hospital, while having covid. discussed her recovery emotionally and physically so far, troubles with breastfeeding as far as baby/s latch and tongue tie.

Total Postpartum Hours With Client: 3.5

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

# of text messages during course of care: 75

# of phone calls during course of care: 1

Date Created: January 25, 2022