This form provides the MABC Rural Midwifery Locum Program with a detailed record of the agreement between a Locum and Host midwife regarding the dates of a coverage period.
Locum midwives are responsible for ensuring that the details they submit are agreed to by the Host midwife.
This form determines the amount that host midwife will owe and the amount the locum will be paid for this coverage period according to the Rural Midwifery Locum Program Policy Statement (March 2015). Once submitted, both locum and host will receive a confirmation email with all details of the agreement, for personal records.
If you have any questions or concerns, please contact Sunya Lai Thom (RMLP Program Manager) at firstname.lastname@example.org or 604-736-5976.
Please ensure that all information contained in this form is complete and accurately reflects the locum/host agreement prior to submission.