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Midwife Client Registration Mobile App

The Midwife Client Registration mobile app will be used to complete the birth certificate and to help the midwife provide optimal care. Have the patient answer the following questions which will help determine if there are potential problems which should be discussed further. The app records family history, father of baby (fob), your mother’s history, previous pregnancy outcomes, medical history, gynecologic history, and present pregnancy. This information is completely confidential. All GoCanvas apps can be made HIPPA compliant to make sure client information is confidential and does not violate privacy laws.

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

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Take a peek inside the Midwife Client Registration Mobile App

Included Features

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Included Fields

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

  • Ico statictext

    This information will be used to complete the birth certificate and to help us provide you with o...

  • Ico statictext

    Client Info:

  • Ico textbox

    First

  • Ico textbox

    Middle

  • Ico textbox

    Last

  • Ico textbox

    Maiden Name

  • Ico date

    Date

  • Ico textbox

    Race

  • Ico textbox

    Religion

  • Ico integer

    Yrs Education

  • Ico textbox

    Marital Status

  • Ico textbox

    Occupation

  • Ico date

    Date of Birth

  • Ico dropdown

    State of Birth

  • Ico integer

    SSN

  • Ico textbox

    Address

  • Ico textbox

    City

  • Ico dropdown

    State

  • Ico integer

    ZIP

  • Ico textbox

    Phone

  • Ico statictext

    Father of Baby Info:

  • Ico textbox

    First

  • Ico textbox

    Middle

  • Ico textbox

    Last

  • Ico textbox

    Partner/Husband Name (if different from Father)

  • Ico textbox

    Race

  • Ico textbox

    Religion

  • Ico integer

    Yrs Education

  • ...and More!

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