Date Date Date Signature Signature Signature Appropriate care and referral of the infant to the suitable O/E CD CI health care professional if Date Date Date needed Signature Signature Signature Effectively communicates with the multi-professional O/E CD CI team utilising the situational Date Date Date awareness tool (e.g. SBAR) Signature Signature Signature Provides individualised health information for the E CD CI woman and her family which Date Date Date is easily understood Signature Signature Signature Assesses and responds to parenthood and individual E CD CI Date Date Date needs Signature Signature Signature for women and families *O E/CD CI suffering pregnancy loss Date Date Date
Date Date Date Appropriate care and referral of the infant to the suitable health care professional if needed O/E Signature CD Signature CI Signature Date Date Date Effectively communicates with the multi-professional team utilising the situational awareness tool (e.g. SBAR) O/E Signature CD Signature CI Signature Date Date Date Provides individualised health information for the woman and her family which is easily understood E Signature CD Signature CI Signature Date Date Date Assesses and responds to parenthood and individual needs E Signature CD Signature CI Signature Date Date Date for women and families suffering pregnancy loss *O Signature E/CD Signature CI Signature Date Date Date