Family Medicine

Maternal, Child, and Reproductive Health 

MCH Clinical Forms

This page allows accessibility to clinical forms for health care providers throughout the entire MCH network. Simply click on the hyperlink to begin download.

Anesthesia Consult Request  

• Now available as an Ad Hoc in Powerchart 
• Anesthesia Pre-Op Clinic Consult Request Form - if patient does not have PCO MRN 

Birth Preferences @ UNM Forms

•  Birth Preferences English
•  Birth Preferences Spanish
•  Birth Preferences Vietnamese 

Blood Product Refusal 

• Approach to the Patient that Refuses blood products

• What Blood Products are you willing to receive? 

Breast Pumps Prescribing Information

•  Breast Pump Prescription Codes

Buprenorphrine Consent

•   MCH Buprenorphine Patient Agreement.docx

Cesarean Section

• UNM Patient Education Preparing for your cesarean section 
• UNM How to Clean Your Skin Before your C-section

• What Every Pregnant Woman Needs to Know About Cesarean Section

• Birth Choices After a Cesarean Section
• TOLAC Consent Form
• TOLAC Consent Form (Spanish) 
• Instructions for Scheduled Cesarean Sections
• Instructions for Scheduled Cesarean Sections (Spanish) 

Father of Baby Testing

• Father of Baby testing Form  (for alloimmunization in pregnancy)

Genetic Testing

• Informed Consent for Genetic Analysis
• Tricore Quad/Triple Screen Information Form 
• ARUP Maternal History Information Genetic Screening Request Form 

Gentle Cesarean Section

•   Gentle C-section SOP
•   Gentle C-section Patient Handout

High Risk Fund

•  High risk fund application

•  High risk fund indications

Home Visiting Common Referral Form

• Home visiting referral form 

IUFD on L&D Information

• Information on ordering genetics and caring for IUFDs on L&D 

Misoprostol for Miscarriage Protocol

•   Protocol for Use of Misoprostol for Miscarriage.doc
•   Patient Information for Use of Misoprostol for Miscarriage

Nitrous Oxide for Labor

•   Nitrous Oxide for Labor
•   Nitrous Oxide for Labor - Spanish
•   Nitrous Oxide for Labor - Vietnamese

Photography Consents

•  Photography Consent for Patients
•  Consent for patients for posting to social media

Planned Delivery Scheduling Form

•   UH Planned Delivery Scheduling Form.pdf

Prenatal Audit Flowsheets 

•  Prenatal Audit Flowsheet

Sterilization Consent for Medicaid (Tubal Consent)

•   Sterilization Consent English
•   Sterilization Consent Spanish

Syphilis

• Diagnosis and Management of Syphilis During Pregnancy 

TOLAC Consents 

•   TOLAC Consent Form
•   TOLAC Consent Form (Spanish) 

UNM Patient Education Handouts

•      https://hsc.unm.edu/health/patient-care/womens-health/patient-education.html