Confidentiality Release
Client Confidentiality Release Form
Birth and Postpartum Services
Due to current confidentiality regulations all doulas should have a signed release form from their client before taking any notes about them, their labor, birth or postpartum. 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. Clients should receive a copy of the form they signed, and the doula should have her copy with her at all times to be able to show that she is indeed complying with the confidentiality 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.
I, (Client), give my permission, for my Get Babied! doula to take notes about me, including personal information I choose to disclose to her and information regarding my labor, birth and postpartum, as well as any information regarding my child/ren. I realize that this information will be shared with the doula that is providing back up support. I also understand that this information may anonymously be used for the DONA Data Collection for statistical purposes, and that my Get Babied! doula may use this information to provide me with a summary for my own personal use.
