Anyone who resides in Logan County is eligible to receive a Welcome Home Baby Visit.

We Will Discuss During Our Visit:

Your health and your baby’s health
Breast or bottle-feeding your baby
Safety issues for babies
How to tell if your infant is ill and when to call the doctor
Infant sleep/wake patterns and expected changes
The way babies communicate with their caregivers
Ways to understand infant cries, how to comfort the crying baby, normal changes in infant crying
Help from family and friends
Community resources you may be interested in for you or your baby
Postpartum depression
Questions and concerns that you may have

Our newborn staff consists of registered nurses with newborn and postpartum knowledge. As Welcome Home Baby visiting nurses we are here to: welcome you home, provide an assessment of mother and child, answer questions, link families to services and resources within our community, and provide information to keep your new baby healthy, safe and happy.

Call the Health District at 937-651-6186 to request more information.

Ohio Department of Health’s Safe Sleep 101 Video

Welcome Home Baby Visit Form

Newborn Baby Visit

A registered nurse provides this free consultation and conducts the following:

Measure baby’s weight
Answers newborn care questions
Provides education material specific to parental need

The Newborn Baby Visit program can help provide peace of mind for parents as a baby’s growth and well-being are evaluated by healthcare professionals. If you are interested in this program, please complete this form, which will be sent to the health department of your residing county.

Name of Parent

First Name

Last Name

Age of Parent

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County of Residence

Primary Language:

Interpreter needed?

Phone

(###)

###

####

Permission to Text?

Preferred Method of Contact

E-Signature

Date

YYYY

Mom's Name

First Name

Last Name

Date

YYYY

Method of Delivery

Race

How many times have you been pregnant?

How many times have you given birth?

Pregnancy Complications or Related Conditions:

Gestational Diabetes

High Blood Pressure

Pre-eclampsia

HELLP Syndrome

Anemia

Depression/Post Partum Depression

Hemorroids

Vaginal Lacerations from birth

Physician/Clinic Name:

Next Appointment Date

YYYY

Discharged Date

YYYY

Allergies

Prescription Medications/OTC Medications/Vitamins/Herbs

Significant Medical History:

· This referral is voluntary. I understand that I may revoke with authorization at any time prior to information being shared with the Newborn Baby Visit Program in the county which I reside.

· I understand that my authorized information may be subject to re-disclosure and may no longer be protected by the Health Insurance Portability and Accountability Act of 1996.

Welcome Home, Baby!

Welcome Home Baby Visit Form

· This referral is voluntary. I understand that I may revoke with authorization at any time prior to information being shared with the Newborn Baby Visit Program in the county which I reside.

· I understand that my authorized information may be subject to re-disclosure and may no longer be protected by the Health Insurance Portability and Accountability Act of 1996.

· This referral authorization will expire at the conclusion of the referral.

· My signature authorizes this referral to be sent to the Logan County Health District.