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Doula Client Confidentiality Release Form Mobile App

Due to the HIPAA regulations all doulas should have a signed release form from their client before taking any notes about them or their labor. The best way to be fully compliant would be to get this release signature at the first prenatal visit, or upon first meeting and joining the client for her labor and delivery. Certification candidates should have this form signed before taking any notes. Clients should receive a copy of the form they signed, and the doula should have her copy with her at the labor and birth to be able to show that she is indeed complying with the HIPAA regulations if questioned. Confidentiality of medical and personal information obtained during the course of the doula’s work is of the utmost importance. Failure to comply with these confidentiality regulations could result in penalties.

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Included Features

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Included Fields

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Due to the HIPAA regulations all doulas should have a signed release form from their client befor...
I,
at (address),
(phone#),
give my permission, for my doula,
to take notes about me, including personal information I choose to disclose to her, and informati...
Signature:
Date:
...and More!