Section R9-16-114. Midwife Report after Termination of Midwifery Services

A.      A midwife shall complete a midwife report for each client, in a format provided by the Department, that includes the follow- ing:

1.        The midwife’s:

a.         First name,

b.        Last name, and

c.         License number;

2.        The client’s:

a.         Date of birth;

b.        Client number;

c.         Date of last menstrual period;

d.        Estimated date of delivery;

e.         Gravida (number);

f.         Para (number); and

g.        If applicable, whether the client had a vaginal deliv- ery after prior Cesarean section or vaginal delivery of a fetus in a complete breech or frank breech pre- sentation;

3.        A description of the maternal outcome, including any complications;

4.        If a vaginal delivery after prior Cesarean section or vagi- nal delivery of a fetus in a complete breech or frank breech presentation:

a.         Rate of dilation, and

b.        Duration of second stage labor;

5.        If applicable, the newborn’s:

a.         Date of birth;

b.        Gender;

c.         Weight;

d.        Length;

e.         Head circumference;

f.         Designation of average, small, or large for gesta- tional age;

g.        Apgar score at 1 minute;

h.        Apgar score at 5 minutes;

i.         Existence of complications;

j.         Description of complications, if applicable;

k.        Birth certificate filing date; and

l.         Birth certificate number, if available;

6.        Whether the client required transfer of care and, if appli- cable:

a.         Method of transport,

b.        Type of facility or individual to which the midwife transferred care of the client,

c.         Name of destination,

d.        Time arrived at destination,

e.         Confirmation the emergency care plan was utilized, and

f.         Medical reason for transfer of care;

7.        The date midwifery services were terminated;

8.        Reason for the termination of midwifery services;

9.        If termination of midwifery services was due to a medical condition, the specific medical condition;

10.     Whether information was provided on newborn screen- ing; and

11.     Whether   newborn   screening    tests   were   ordered   as required in A.R.S. § 36-694.

B.       The midwife shall submit a midwife report for a client to the Department within 30 calendar days after the termination of midwifery services to the client.

Historical Note

Section made by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2).