For Clients
FIRST:
Anyone desiring care from Lorri, even telehealth consults, will need to first sign this Vaccine Exemption Form. You can sign, scan, and email it, or upload it to DocuSign and send it to Lorri. It can also be signed, a good clear photo taken, and texted to Lorri.
Information and documents (below) to read and download.
Many of them will require your signature.
We will provide you with a complete set of documents,
so there is no need to print them out unless you need a new copy.
Extra Info:
Radiation Exposure: sources of Iodine to protect your thyroid.
After Birth Control: ways to Cleanse Your System prior to conceiving.
Washington State Insurance Commissioner: file a Complaint if you have problems with your insurance company (like denials of claims, or slow pay). This form gives the Commissioner the ability to investigate and act on your behalf, otherwise he cannot help you!
Micronutrient Needs During Pregnancy and Lactation. Required disclaimer: "This link leads to a website provided by the Linus Pauling Institute at Oregon State University. Highland Midwife is not affiliated or endorsed by the Linus Pauling Institute or Oregon State University." Excellent information!
Packet 1:
Important documents to read before your first midwifery appointment.
Informed Choice for Midwifery Care & Home Birth
(this document is being heavily revised in 2021).
Required form for Oregon until that license is renewed after covid mandates are dropped: until such time Lorri is only offering attendance in Oregon as a Traditional Midwife.
Client-Midwife Contract
(signature required for you to become my client).
Financial Agreement & Payment Schedule
(signature required, sets out the details of your payment arrangements).
Choices for Payment Options
explains different ways to pay for your care, being revised.
Indications for Physician Consultation & Referral
(signature required, conditions & situations for which I consult or refer).
Medical Records Request / Release
(to have health care records sent to me from other providers).
Insurance Information Form
(needed if you intend to use our biller to help you with insurance).
Insurance Benefits Questionnaire - the ultimate tool for interviewing your insurance company to determine your benefits.
MANA Statistics - Midwives Alliance of North America
(disclosure & consent to collect limited research data).
Genetic AFP Screening - for specific birth defects
(informed choice for prenatal risk screening test at 15-20 weeks).
Ultrasound & Doppler Use - informed choice; risks and benefits of fetal imaging and/or use of doppler fetoscope during pregnancy.
Vaginal Birth After Cesarean - only for moms with previous C-sections
(informed choice for mothers considering VBAC).
Additional Info for early pregnancy:
When to Call Your Midwife (with contact info) and
If Your Bag of Water Breaks. Print and post this at home.
Practice Guidelines
(describes my typical client care in more detail).
Charting My Pregnancy / Labwork in Pregnancy
(helps you track your care and explains routine prenatal labwork).
HIPAA Notice - as it affects my policies and procedures
(Health Insurance Portability and Accountability Act info).
The requirements for informed disclosure set by NARM, which are all of the documents here plus the complaint process.
Exercises for Pregnancy
to relieve discomfort in pelvis, hips, low back.
Weighing the Risks and Benefits; additional reading
to learn why I rarely recommend ultrasound.
A technical examination of the safety levels of commonly-used ultrasound by Eudine Stevens.
Due Dates - OB Calculator, prints on one page
(a link to a fun resource for calculating your dates).
Due Dates - OB Calculator from ATM
(if you prefer a traditional calendar-style dates report).
Packet 2:
To read during your second trimester.
Informed Consent for Glucose Tolerance Testing
for gestational diabetes (done between 24 & 28 weeks).
Informed Consent for RhoGam, only moms with Rh-negative blood types (done at 28 weeks and again at birth).
Emergency Transport Information
(info we will take with you if you go to the hospital).
Hospital Transport Plan
(needs to be decided and filled out well in advance of labor).
Informed Consent for Vitamin K Prophylaxis
(includes alternatives, some of which start at 30-32 weeks).
Additional Info for mid-pregnancy:
The 4 Stages of Labor
(defines and describes labor and delivery).
Parent's Guide brochure; information that I am required to offer, not necessarily something that is endorsed.
Article reprinted by permission; critical information about both circumcision and care of intact boys. Active links.
Packet 3:
To read as you enter your third trimester.
Informed Choice for Group B Streptococcus
(testing is done after 34 weeks gestation).
Prophylactic Antibiotic Eye Ointment
(informed choice for newborn treatment).
Map & Directions to Birth
(so we can easily find your home, even in the dark!).
Important:
You should order your birth kit no later than 34 weeks.
Custom Birth Kit for Highland Midwife
(click tab to order, select whether you need it shipped or not).
Additional Info for late pregnancy:
Pulse Oximetry options
(screening for Critical Congenital Heart Defects).
Birth Supplies List, items in addition to your Birth Kit - above
(things to have ready at home before 37 weeks).
Labor Tub Use & Care
(how to clean, set up, and fill the tub that I will loan you).
Video - How to set up your home for a birth
(easier than you think).
Video - What your midwife will bring along in her bag
(all the equipment that we almost never use).
Same as "When to Call Your Midwife" above
to print and post in your home if you haven't already.
How to deliver without assistance (in the unlikely event that you ever have to, & assuming you took our birth class).
Newborn Screening; what it is, why it is done, prices in Washington and Oregon. Parental refusal is still optional at home.
Postpartum Instructions for Mom & Baby
(Important information about your care after the birth).
Instructions for Visitors, for parents who want (or need!)
to post helpful reminders after the birth.
Growth chart for newborn to 2 years;
boys and girls, height and weight, adjusted for breastfed babies.
After the birth:
Things you may need later.
If your insurance is through Apple Health (state of WA), you MUST add your baby within a week of birth! Instructions here.
How to order a Washington Birth Certificate; I send the info
to the state within 10 days, and you order the certificate directly.
How to order an Oregon Birth Certificate; I mail the info
to the state within 5 days, and you order the certificate directly.
How to file a complaint with NARM.
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