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PERINATAL LOSS SUPPORT PROGRAMTEACHING MANUALUpdated April 2017Page 1AcknowledgementsPage 2Table of Contents PERINATAL LOSS SUPPORT PROGRAM TEACHING MANUAL PURPOSE: .......... 5 PERINATAL LOSS COMMITTEE

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How to fill out perinatal loss

01

To fill out perinatal loss, follow these steps:

02

Begin by providing basic information about the person filling out the form, such as their name, contact details, and relationship to the deceased.

03

Specify the details of the perinatal loss, including the date and time of the incident, the gestational age if applicable, and any medical information available.

04

Describe the circumstances surrounding the perinatal loss, whether it occurred during pregnancy, childbirth, or shortly after delivery.

05

Include any emotional or physical symptoms experienced by the mother or family members following the loss.

06

Provide information about any medical interventions, treatments, or procedures that were performed in relation to the perinatal loss.

07

If there were any witnesses present during the incident, their names, contact details, and statements can be included in the form.

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Finally, conclude the form by signing and dating it to verify its accuracy and authenticity.

Who needs perinatal loss?

01

Perinatal loss forms are typically needed by healthcare professionals, legal authorities, and support organizations.

02

Healthcare Professionals: Perinatal loss forms help doctors, nurses, and other healthcare providers in documenting and analyzing the circumstances and details surrounding the loss. This information can assist in understanding potential causes and improving future care strategies.

03

Legal Authorities: Perinatal loss forms may be required in legal procedures, such as investigations or legal claims. These forms provide an official record of the incident and can be used as evidence if necessary.

04

Support Organizations: Support groups, counseling centers, or organizations specializing in perinatal loss may request these forms to offer support, guidance, or advice to families who have experienced such losses. The information helps these organizations tailor their services to meet the specific needs of the affected individuals.

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What is perinatal loss?

Perinatal loss refers to the death of a baby before, during, or shortly after birth.

Who is required to file perinatal loss?

Healthcare providers or medical facilities where the perinatal loss occurred are required to file perinatal loss reports.

How to fill out perinatal loss?

Perinatal loss reports are typically filled out by healthcare providers or medical staff who were involved in the care of the baby and mother.

What is the purpose of perinatal loss?

The purpose of perinatal loss reporting is to gather data for research, statistics, and improving maternal and neonatal care.

What information must be reported on perinatal loss?

Information such as the baby's gestational age, birth weight, cause of death, and maternal health history must be reported on perinatal loss forms.

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