1. A. A midwife shall obtain a written informed consent for midwifery services in a format provided by the Department that contains:

   1. 1. The midwife’s:

      1. a. Name,
      2. b. Telephone number,
      3. c. License number, and
      4. d. E-mail address;

   2. 2. The client’s:

      1. a. Name;
      2. b. Address;
      3. c. Telephone number;
      4. d. Date of birth; and
      5. e. E-mail address, if applicable;

   3. 3. An attestation that the client was:

      1. a. Provided the information required in R9-16-108(C)(1);
      2. b. Informed of the emergency care plan as required in R9-16-108(D); and
      3. c. Given an opportunity to have questions answered, have an understanding of the information provided, and choose to continue with midwifery services; and
   4. 4. The signatures of the client and midwife and date signed.
2. B. A midwife shall ensure that the written informed consent for midwifery services is placed in the client record.

3. C. A midwife shall ensure that a copy of the written informed consent for midwifery services is provided to the:

   1. 1. Client, and
   2. 2. Department within five calendar days after a Department request.

Historical Note

Adopted effective March 14, 1994 (Supp. 94-1). R9-16-109 renumbered to R9-16-112; new Section R9-16-109 made by exempt rulemaking at 19 A.A.R. 1805, effective July 1, 2013 (Supp. 13-2). Manifest typographical errors corrected in subsections (A)(3)(a) and (b) to rule Section reference of incorrect Chapter number; request made by Department at file number R13-232 (Supp. 13-3). Section amended by final expedited rulemaking at 28 A.A.R. 1119 (May 27, 2022), with an immediate effective date of May 4, 2022 (Supp. 22-2).