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Informed Choice and Disclosure Form

TDLR has revised and updated the Licensed Midwives Informed Choice and Disclosure Form. The form includes a new requirement to provide information to prospective clients on hospital transfer.

The form is available online in English and Spanish at: https://www.tdlr.texas.gov/midwives/mwvforms.htm

Question: The new Informed Choice and Disclosure Statement Form only includes two spaces for me to list the hospitals to which I will transfer a specific client. What if there are more than two hospitals that I might transfer my client to?

Answer: If you need more space, please attach a separate page to the form listing the hospitals to which you might transfer a specific client, and then discuss the information with that client.

Please note: this list should not be a generic list of all hospitals in the area โ€“ it should be tailored to the planned birth location of each specific and individual midwifery client.