Cardiac Conditions in Obstetric Care Letter of Intent

Our facility is interested in joining the Cardiac Conditions in Obstetric Care initiative. The following form contains introductory information about our team.

1. Name of Facility: *This question is required.

2. Name of Contact Person: *This question is required.

3. Work Phone Number for Contact Person: *This question is required.

4. Work Email for Contact Person: *This question is required.

5. Our unit has a QI team. *This question is required.

6. Our team has an active family member. *This question is required.

7. Our team has a member of senior leadership. *This question is required.

8. How many deliveries does your unit do a month?