Labor And Delivery Unit Guidelines Acknowledgment Form
Please review and acknowledge the guidelines for the Labor and Delivery Unit. This form is for staff and others confirming their understanding and compliance with unit policies.
Full Name
*
First Name
Last Name
Role/Position
*
Please Select
Registered Nurse
Physician
Midwife
Unit Clerk
Support Staff
Other
Department/Unit
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Acknowledgment
*
-
Month
-
Day
Year
Date
Shift
*
Day
Evening
Night
Other
I acknowledge that I have received and read the Labor and Delivery Unit Guidelines.
*
I have received and read the guidelines
I understand the key operational expectations for the Labor and Delivery Unit.
*
I understand the operational expectations
I confirm that I will comply with all unit policies and patient safety procedures.
*
I confirm compliance with policies and safety procedures
Questions or Comments
Signature
*
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: