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Please print and sign this page to indicate that you have read and understand the Planned Home Birth document. Please send this signed page back to our office by mail. I certify that I have read the Planned Home Birth document and plan to fulfill these standards of care for home births as recommended by the American Academy of Pediatrics:___Date:___ Mothers Signature___Date:___ Fathers Signature___ Mothers Printed Name___ Fathers Printed Name___ Phone NumberBabys Expected
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