1. your full name and date of birth
2. your insurance company, ID number, and who is the primary insured. (you? your spouse or parent? their full name and date of birth. I will also need to be made aware if there is a secondary insurance plan. If the plan you are using for my services is the secondary plan, I need to know that
3. your address and parking instructions (Travel more than 15 miles each way will incur a $25 out of area convenience fee withich is NOT reimburseable by insurance. check or cash is fine
4. who can I thank for the referral? (a friend, your Pediatrician? Google? Your insurance carrier?)
5. OB/Midwife name and either a phone number or the practice name and location
6. Pediatrician name and either a phone number or the practice name and location
7. Any medical conditions that you have and any medications that you take. How many pregnancies? Did you breastfeed the others?
8. Any information about your pregnancy that was unusual (did you have gestation diabetes? thyroid issues? infertility? high blood pressure?)
9. Labor and delivery information (epidural? forceps? vacuum? long labor? tearing? excessive blood loss? any other complications?
10. Delivery type (Vaginal? unplanned C-section? emergency C -section? Planned C-section?) where?
11. did your breasts increase in size in puberty? again in pregnancy? after delivery?
12. How is breastfeeding going and reason for consult
13. your goals for breastfeeding
14. your baby's full name and date of birth and gender
15. your baby's birth weight and any weights done since then
16.any complications your baby experienced after birth (high bilirubin? or anything else)
17. anything else you think I should know
I am sorry that you had trouble with my electronic medical records.
kindly answer the following questions in an email and send back to me as soon as possible