Okla. Admin. Code § 310:395-5-4

Current through Vol. 42, No. 4, November 1, 2024

Section 310:395-5-4 - Disclosure forms

(a) A Licensed or Unlicensed Midwife shall disclose verbally and in written form to a prospective Client at the outset of the professional relationship items 1 through 14 of this section. This discussion must be documented by use of a disclosure form. It must be signed and dated by the Client at the same time the Licensed or Unlicensed Midwife and Client enter into an agreement for services. This form must be filed in the Client's medical record. The disclosure shall include:

(1) The Midwife's name, and the license number and expiration date if applicable;

(2) The Client's name, contact information, and the name of the Client's primary care provider if the Client has one;

(3) A statement that the Midwife is not an advanced practice registered nurse-midwife;

(4) Credentials of the Midwife;

(5) Documentation of compliance with continuing education requirements if the Midwife is licensed;

(6) Disclosure of years of service as a Midwife;

(7) A description of the plan or protocol for transfer to a hospital;

(8) The limitations of the skills and practices of the Midwife;

(9) Whether the Midwife carries malpractice insurance;

(10) Emergency Plan - As part of the disclosure form, an individual emergency plan must be established by the Licensed Midwife and Client. The plan must include:

(A) The Client's name, address, and phone number;

(B) The arrangements for transport from the delivery site to a nearby hospital;

(C) The name, address and phone number of the hospital with obstetric services that will be used for emergency transfer;

(D) The name, address, and phone number of the hospital with obstetric services that will be used for non-emergency transfer; and

(E) The name and phone number of any Clinician providing backup care or co-care to the Client;

(11) Direction on where to find scope of practice standards of a Licensed Midwife, as provided by rules of the Commissioner;

(12) Notification that state law requires a Newborn to be tested for certain heritable disorders, hearing screening and hypothyroidism, in the absence of a signed parental waiver;

(13) Procedures for reporting a complaint to the Department; and

(14) Any additional information or requirement that the Department deems necessary to protect the health, safety, or welfare of the Client.

(b) The Department will provide a template Disclosure Statement providing this information on its website.

(c) Before the onset of labor, the midwife's agreement can be terminated at any time that the midwife deems it necessary for maintenance of the Client's mental and physical safety or for compliance with these rules. When termination occurs, the reasons for termination will be given in writing and an alternative source of care recommended; and

(d) The Client may terminate the agreement at any time.

Okla. Admin. Code § 310:395-5-4

Adopted by Oklahoma Register, Volume 38, Issue 06, December 1, 2020, eff. 11/2/2020

Adopted by Oklahoma Register, Volume 38, Issue 12, March 1, 2021, eff. 2/2/2021

Adopted by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/11/2021