logo color FormHeader OB
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First Name *MILast Name *

Congratulations! Pregnancy can be one of the happiest times in your life. It can also be very frightening because of the extreme changes. Knowing what to expect can make everything easier.

Pregnancy should not be considered a “disease” – it is a natural and wonderful part of your life. At the same time, it is our job to try to keep both patients – you and your baby – healthy. For this reason, there will be testing done during your pregnancy. Routine blood tests, testing for diabetes and anemia will also be done during your pregnancy. If there are complications, you may need additional blood and urine tests, repeat ultrasounds, or non-stress tests (monitoring the baby’s heartbeat) all of which can be done in our office or through a very reliable outside facility, depending on the problems that arise. If you feel ill enough to miss work and want to use FMLA or have a doctor’s excuse, you need to call at the time of illness for evaluation.

We feel prenatal classes are important. We recommend the classes offered through Liberty Hospital, including childbirth preparation, sibling, and breast-feeding. They should be scheduled around 28 weeks of pregnancy. We do not recommend the Bradley Method classes that are currently being taught North of the river, as we feel they encourage an adversarial relationship between parents and their physicians. If you do plan to take the Bradley classes, please notify us as we will then recommend another group of physicians where we can transfer your care too.

Your “due date” is typically 40 weeks after your last period and at each visit we will refer to how far along you are by weeks, not months. The baby is term (not premature and not overdue in a medical sense) from three weeks before your due date to two weeks after. We deliver only at Liberty Hospital. It is a community hospital where you and your family will receive personalized attention; they are extremely well equipped and able to handle most emergencies. While you are in labor, you will have an IV and the baby’s heartbeat will be monitored for safety.

You become very special to us during your prenatal care, and we would like to deliver each of our own patients. However, this is impossible, in that we cannot be good physicians and make good decisions if we are consistently up several nights in a row. Therefore, we do follow a call schedule and you will be delivered by the physician on call on that particular day.

Your family members are welcome to come with you for prenatal visits and ultrasound appointments.

Please feel free to ask questions! We want to make sure you understand what is going on during your pregnancy.

Again, CONGRATULATIONS!!!

I have read and understand the policy of Northland Women’s Health Care, PC.
Patient Signature – Draw your signature below using a tablet, mouse or smartphone. By clicking the Submit button at the end of this form I understand and agree that this is a legal representation of my signature.

logo color FormHeader Ultrasound

You can expect to have one or more ultrasounds during your pregnancy. There are limitations with ultrasound. An ultrasound is not able to detect all fetal abnormalities, nor predict all pregnancy outcomes.

I have read and understand the ultrasound statement of Northland Women’s Health Care, PC.
Patient Signature – Draw your signature below using a tablet, mouse or smartphone. By clicking the Submit button at the end of this form I understand and agree that this is a legal representation of my signature.

logo color FormHeader HIV

Our doctors are encouraging HIV testing for all new obstetric patients, regardless of risk factors. The reasons for this are because:
   1) Of HIV+ women, a significant portion have no risk factors;
   2) Treatment of HIV in pregnancy will markedly reduce the risk of transmission to the baby.

If you would like HIV testing, please read and sign the consent below.

HIV Testing Consent

I have been informed that my blood will be tested in order to detect whether or not it contains antibodies to the human immunodeficiency virus (AIDS). I understand that the test is performed by drawing blood from my arm and processing the resulting specimen utilizing ELISA and Western Blot laboratory technology.

I have been informed that the ELISA test being utilized produces three (3) false positive (indicates the presence of anti-HIV when it is not present) test results in every ten thousand (10,000) specimens processed, regardless of population. If the initial test is positive, a secondary level test (Western Blot) will also be performed. The combination of these tests reduces the possibility of a false positive to a very small fraction per ten thousand (10,000) tests performed.

I have been informed that the ELISA also fails to detect anti-HIV in rare instances and for a period of time immediately after infection with the virus. I have been offered re-testing if it is suspected that this has occurred.

I have been informed that if I have any questions regarding the nature of the blood test, its expected benefits, its risks, and alternative tests, I may ask those questions before I decide to consent to the blood test.

I understand that positive test results must be reported by name to the Missouri Department of Health and that confirmed HIV antibody test results will be made available beyond that - only in summary or statistical form so that individuals cannot be identified.

By my signature below, I acknowledge that I have been given all the information I have requested concerning the blood test and the release of results. Therefore I acknowledge that I HAVE given consent for the performance of the blood test to detect antibodies to HIV.


  Patient’s Name
 
  Patient or Guardian Signature  

***  OR  ***

By my signature below, I acknowledge that I have been given all the information I have requested concerning the blood test and the release of results. Therefore I acknowledge that I DO NOT give consent for the performance of the blood test to detect antibodies to HIV.


  Patient’s Name
 
  Patient or Guardian Signature