Documentation: Postpartum Appointment Appointment date * MM DD YYYY Appointment start * Hour Minute Second AM PM Appointment location * client's home provider's office audio/video telehealth - client home audio/video telehealth - client other audio telehealth - client home audio telehealth - client other community location or shared space other Client name * First Name Last Name Date of birth * MM DD YYYY Delivery date * MM DD YYYY Assessment of Maternal Physical Health Perineal healing * Incision healing * Core strength * Light exercise/daily activities * Nourishment/diet * Counsel client to continue taking prenatal vitamins and any other prescribed medications. Postpartum complications * Other Assessment of Maternal Mental Health Baby blues * Risk factors for PMADs * Refer to Prenatal 1 documentation for information on past mental health history. Therapy * Explain whether the client has established care with a therapist, actively seeing a therapist, etc. Rest * Sunlight/fresh air * Other Assessment of Sleep Infant sleep location * Check all that apply. shared room with parents shared room with sibling(s) own room/nursery living room/common area other Infant sleep surface * Check all that apply. contact sleep/on caregiver bassinet crib dock-a-tot/hugging pillow adult bed playard/playpen other carseat sofa Infant wake window * How long baby can stay awake in between naps - enter a number value *IN MINUTES* Longest sleep stretch * The longest baby has stayed asleep - enter a number value *IN HOURS* Average number of sleep hours per night for mother * Enter a number value *IN HOURS* this does not have to be consecutive sleep. Average number of sleep hours per night for partner * Enter a number value *IN HOURS* this does not have to be consecutive sleep. Assessment of Infant Health Number of pediatrician visits so far * Infant growth * Neonatal complications * Umbilical cord healing * Circumcision healing * Infant skin * Other Infant Feeding Type of milk given * breastmilk formula goatmilk other Eating method * breast bottle syringe spoon cup other Breastmilk supply * Number of total feeds per day * Number of bottles per day * Number of ounces per bottle * Number of latches per day * Number of minutes per latch (average) * Assessment of Newborn Care Number of wet diapers per 24 hour period * Number of dirty diapers per 24 hour period * Infant bonding/baby wearing * Infant soothing * Infant bathing * General Considerations Assessment of transition to (new) parenthood * Assessment of postpartum plan * Refer to Prenatal 3 documentation and report on how closely family is following original postpartum plan. Adjustments of/to other children and/or pets * Concerns * Recommendations * Resources * Appointment end time * Hour Minute Second AM PM Signed (doula provider) * Thank you!
