H Written Protocol for Consultation/Transfer/Transport

Section 640 Section 640.APPENDIX H   Written Protocol for Consultation/Transfer/Transport Section 640.EXHIBIT D   Level II : Maternal and neonatal patients to be cared for at _________________ hospital (Level III hospital or Administrative Perinatal Center) 1)         Maternal A)        The maternal patient with uncomplicated current pregnancy. B)        Patient with normal current pregnancy, although previous history may suggest potential difficulties. C)        Patient with selected medical conditions, such as mild hypertension or controlled thyroid disease, when there is no increase in perinatal morbidity. D)        Patient with selected obstetric complications such as pre-eclampsia or premature labor greater than 34 weeks. E)        Patient with an incompetent cervix. F)         Patient with gestational diabetes. 2)         Neonatal A)        Patients greater than 34 weeks gestation or greater than 1800 grams without risk factors. B)        Patients with mild to moderate respiratory distress (not requiring assisted ventilation in excess of 6 hours). C)        Patients with suspected neonatal sepsis, hypoglycemia, neonates of diabetic mothers and post-asphyxia without life-threatening sequelae. D)        Premature infants greater than 1800 grams who are otherwise well.