Section Mid 407.02 - Significant Morbidity and Mortality Report FormWhen reporting an incident of maternal or neonatal significant morbidity or mortality, a midwife shall provide the following information on the "Significant Morbidity and Mortality Report Form" provided by the midwifery council and available on the boards web site, https://www.oplc.nh.gov/midwifery-council-forms-and-documents:
(a) The name of the midwife;(b) The Midwife's address;(c) The Midwife's phone number;(d) The midwife's certification number;(e) The name of the client;(f) The client's address and phone number;(g) The client's date of birth;(h) The newborn's name and date of birth, if applicable;(i) The location of the incident of significant morbidity or mortality;(j) If the client or newborn was transferred to a hospital:(1) A detailed description of the reason for the transfer of the care of the client or newborn to the hospital;(2) The name and location of the hospital to which the care of the client or newborn was transferred and the phone number of the hospital's medical records department;(3) The date and time of the call for transportation to the hospital;(4) The date and time the client or newborn arrived at the hospital; and(5) The means of transportation to the hospital;(k) A detailed description of the maternal illness, injury, or morbidity, and outcome;(l) A detailed description of the newborn's illness, injury, or morbidity, and outcome;(m) A detailed description of any additional significant concerns or information; and(n) The midwife's signature and date of signing.N.H. Admin. Code § Mid 407.02
Amended by Volume XXXVI Number 49, Filed December 8, 2016, Proposed by #12040, Effective 11/10/2016, Expires 11/10/2026.Amended by Number 19, Filed May 11, 2023, Proposed by #13611, Effective 6/13/2023, Expires 6/13/2033.