LAC 46:XLV.5313. Informed Consent

A. Prior to providing any services, a licensed midwife shall obtain the written informed consent, in writing, of the client, which shall include but not be limited to the following: 1. the name and license number of the licensed midwife; 2. the client’s name, address, telephone number, and the name of the client’s primary care provider if the client has one; 3. a statement that the licensed midwife is not an advanced practice registered nurse midwife or physician; 4. a description of the education, training, continuing education, and experience of the licensed midwife; 5. a description of the licensed midwife's philosophy of practice; 6. a statement recognizing the obligation of the licensed midwife to provide the client, upon request, separate documents describing the law and regulations governing the practice of midwifery, including the requirement for an evaluation and examination by a physician, the protocol for transfer or mandatory transfer, and the licensed midwife's personal written practice guidelines; 7. a description of the plan or protocol for transfer to a hospital; 8. a complete and accurate description of the services to be provided to the client; 9. whether the licensed midwife maintains a professional liability policy and if insurance is maintained, a description of the liability conditions and limits of such insurance; and 10. any additional information or requirement which the board deems necessary to protect the health, safety, or welfare of the client.