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Assertion to Decline Tests Required within 28 Weeks Midwife Mobile App

Midwives can use the Assertion to Decline Tests Required within 28 Weeks Midwife mobile app with a smartphone or tablet to have their patients sign and acknowledge their refusal to required 28 weeks pregnancy tests. The app includes test name and details, risk to mother and risks to unborn child.

GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

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Take a peek inside the Assertion to Decline Tests Required within 28 Weeks Midwife Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name of Midwife:

  • Ico textbox

    ADHS License #:

  • Ico textbox

    Midwife’s Phone #:

  • Ico textbox

    Midwife’s E-mail:

  • Ico textbox

    LM Client File #:

  • Ico textbox

    Client’s Name:

  • Ico date

    Date of Birth:

  • Ico textbox

    Client’s Ph.

  • Ico textbox

    Client’s E-mail:

  • Ico textbox

    Client’s Street Address:

  • Ico textbox

    City:

  • Ico dropdown

    State:

  • Ico integer

    Zip:

  • Ico statictext

    The Midwife and the Client affirm with their signatures below that the client has declined the on...

  • Ico signature

    Midwife Signature:

  • Ico date

    Date:

  • Ico dropdown

    Test

  • Ico date

    Date Declined

  • Ico signature

    Client Signature

  • Ico signature

    Midwife Initials

  • ...and More!

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