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Covers emergency and non-emergency transfer planning during pregnancy, labor, and postpartum, including typical transfer procedures, record transfer expectations, and transport options. Includes sections to list nearest and preferred hospitals, driving times, hospital contact information, emergency contacts, co-care selection for additional providers, newborn care transfer requirements within statutory timeframes, and signature approval by the board.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/individual-transfer-care-plan-for-practice-of-licensed-direct-entry-midwife/353111/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/individual-transfer-care-plan-for-practice-of-licensed-direct-entry-midwife/353111.png","ImageObject",442,249,{"name":88,"@type":89},"Patrick","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-14","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"When can the transfer plan be needed during care?","Question",{"text":109,"@type":110},"Transfer may be needed at any time during pregnancy, labor, or the postpartum period if circumstances arise that require hospital transfer or a higher-level provider.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How are hospitals selected for transport in an emergency?",{"text":114,"@type":110},"When 911 is called, EMS chooses the hospital for transport. The template also asks to list nearest hospital(s) with a labor and delivery unit and their contact details.",{"name":116,"@type":107,"acceptedAnswer":117},"What are the newborn transfer requirements after delivery?",{"text":118,"@type":110},"Within 24 hours the midwife must notify the pediatric health care practitioner of the delivery, and within 72 hours must refer the newborn. 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This can occur at any time during the pregnancy, labor, and postpartum. As part of your home-birth preparation, the midwife considers where you want to transfer care in the event of either an emergency or a non-emergent circumstance. In all situations, your midwife will discuss the concerning symptoms or events with you, and help you determine your best options for transfer location , provider, and means of transport.  \nIn the event of a hospital transfer with [YOUR PRACTICE/NAME HERE], you can expect [midwife to explain their typical transfer procedures, including how records will be provided and who may accompany the client. Include procedures and processes to be undertaken in the event of an emergency for the mother, the newborn, or both in accordance with Md. Code Ann., Health Occ. § 8-6C-08.] .  \nHospitals  \nPlease list the nearest hospital(s) to your house that has a labor and delivery unit, including the address. When 911 is called, Emergency Medical Services (“EMS”) will choose the hospital for transport.  \nNearest Hospital:  \nAddress of Hospital:  \nEstimated driving time in minutes:  \nPhone Number of Hospital:  \n1 Disclaimer: This template is offered for guidance purposes only. It is the responsibility of each licensed direct-entry midwife to individualize this form to your practice and ensure your final form complies with all requirements governing your practice, including but not limited to applicable laws and regulations (such as the Maryland Nurse Practice Act), standards of the North American Registry of Midwives, and other resources from your practice community. If you need legal guidance on development and use of this or other forms in your practice, please consult with your own legal counsel.  \nIf you prefer transport to a different hospital in the case of a non-emergency transport, please list that hospital here, including the address:  \nPreferred Hospital:  \nAddress of Hospital:  \nEstimated driving time in minutes:  \nPhone Number of Hospital:  \nEmergency Contacts  \nIn case ofan emergency, the midwife will contact the following people on your behalf. If you have children, please list the person who will be responsible for their care first.  \nName/ Relationship:  \nPhone:  \nName/ Relationship:  \nPhone:  \nCo-Care or Tandem Care Information  \nYour midwife offers prenatal, birth, and postpartum care services, as discussed separately. Some clients choose to have an additional provider by attending some prenatal visits with a physician, advanced practice registered nurse - certified nurse midwife, or other licensed health care practitioner. Please select your preference:  \n[ ] Yes, I am seeing additional provider(s) during this pregnancy. Please list the name, address, and phone number of your provider(s):  \n[ ] I am not pursuing co-care. In case of a transport, please bring me to the nearest hospital, or in a non-emergency to the preferred hospital I have listed above.  \nPlan of Care for Newborn  \nWithin 24 hours after the delivery, as required by applicable law, the midwife must notify the pediatric health care practitioner of the delivery. Within 72 hours of delivery, as required by applicable law, the midwife must refer the newborn to a pediatric health care practitioner. This includes transferring records for the newborn to the pediatric health care practitioner.  \nPlease list the name, address, phone number, email, and fax number of the pediatric care provider of your choice:  \nPediatric Care Provider:  \nAddress:  \nPhone:  \nFax:  \nAfter the birth, the midwife may provide routine newborn care for up to 72 h","cbCaiqLwVof29RGx","https://ap.wps.com/l/cbCaiqLwVof29RGx","pdf",303420,"English","# Individual Transfer Care Plan\n## Plan for Emergency\n## Hospitals\n## Emergency Contacts\n## Co-Care or Tandem Care Information\n## Plan of Care for Newborn\n## Signature","[{\"question\":\"When can the transfer plan be needed during care?\",\"answer\":\"Transfer may be needed at any time during pregnancy, labor, or the postpartum period if circumstances arise that require hospital transfer or a higher-level provider.\"},{\"question\":\"How are hospitals selected for transport in an emergency?\",\"answer\":\"When 911 is called, EMS chooses the hospital for transport. The template also asks to list nearest hospital(s) with a labor and delivery unit and their contact details.\"},{\"question\":\"What are the newborn transfer requirements after delivery?\",\"answer\":\"Within 24 hours the midwife must notify the pediatric health care practitioner of the delivery, and within 72 hours must refer the newborn. The plan also includes transferring newborn records to the pediatric provider and outlines routine newborn care and screening responsibilities.\"}]","Individual Transfer Care Plan - For Practice of Licensed Direct-Entry Midwife | PDF",1790103108]