The written informed choice and disclosure statement which has been approved by the department shall include:

1. (1) an informed choice statement containing:

   1. (A) statistics of the midwife's experience as a midwife;
   2. (B) the date of expiration of the midwife's license;
   3. (C) the date of expiration of the midwife's adult and infant cardiopulmonary resuscitation and neonatal resuscitation certification;
   4. (D) the midwife's compliance with continuing education requirements; and
   5. (E) medical backup arrangements; and
2. (2) a disclosure statement, which includes the legal requirements of the midwife and prohibited acts as stated in the Act. The disclosure statement may not exceed 500 words and must be in Spanish and English; and must contain;
3. (3) information on where to file a complaint against a licensed midwife, including the name, mailing address and telephone number for the department.

Source Note:The provisions of this §115.121 adopted to be effective October 1, 2016, 41 TexReg 4477.