Midwife to High-Risk Obstetrics Referral Form

Streamline High-Risk Pregnancy Referrals with Paperform

When midwifery care meets complex maternal or fetal conditions, a seamless referral to high-risk obstetrics specialists is critical for ensuring the best outcomes for both mother and baby. Our Midwife to High-Risk Obstetrics Referral Form template provides a structured, comprehensive way to transfer care while capturing all essential prenatal testing results, maternal health history, and delivery planning considerations in one professional document.

Why Use This Referral Form Template?

For midwives, birth centers, and maternal healthcare providers, referring patients to maternal-fetal medicine (MFM) specialists or perinatologists requires clear, complete clinical information. This template helps you:

• Capture comprehensive maternal history including pre-existing conditions, pregnancy complications, and risk factors
• Document prenatal testing results such as ultrasounds, genetic screenings, and laboratory values
• Detail multiple pregnancy specifics for twins, triplets, or higher-order multiples
• Communicate delivery planning considerations and care preferences
• Ensure continuity of care with complete referral documentation
• Save time with a structured format that prompts for all necessary clinical details

Who Benefits from This Template?

This referral form is designed for:

• Midwives in private practice, birth centers, or hospital settings who need to refer patients to high-risk specialists
• Community midwifery practices managing transfers of care
• Birth centers coordinating with hospital-based obstetric services
• Maternal-fetal medicine clinics receiving referrals and needing standardized intake information
• Obstetric practices with collaborative care models between midwives and physicians
• Healthcare administrators streamlining referral workflows between care settings

Key Features of This Template

This form includes conditional logic to show relevant fields based on specific risk factors, ensuring you collect detailed information only when needed. The professional layout guides midwives through:

1. Patient demographics and contact information
2. Current pregnancy details including gestational age and estimated due date
3. Obstetric history with previous pregnancies and outcomes
4. Maternal health conditions and risk factors prompting referral
5. Prenatal testing results from ultrasounds, labs, and genetic screenings
6. Multiple pregnancy details when applicable
7. Current medications and allergies
8. Delivery planning considerations
9. Referring provider information and urgency level

Customize for Your Practice Needs

With Paperform's document-style editor, you can easily adapt this template to match your specific referral protocols, add your practice branding, or modify sections to align with your collaborative care agreements. Conditional logic ensures that only relevant questions appear based on the specific risk factors or complications present.

Automate Your Referral Workflow with Stepper

Once a referral is submitted through Paperform, you can use Stepper to automate the entire referral coordination process. Create workflows that:

• Send automatic notifications to the receiving MFM specialist or perinatologist
• Create patient records in your practice management system
• Schedule follow-up appointments based on urgency level
• Send confirmation emails to the patient with next steps
• Update shared care plans across multiple providers
• Track referral status and completion rates

This automation eliminates manual data entry and ensures no referral falls through the cracks during critical care transitions.

HIPAA Considerations for Healthcare Forms

While Paperform offers robust security features including SOC 2 Type II compliance, encryption, and secure data handling, Paperform is not a HIPAA-compliant solution. Healthcare providers handling protected health information (PHI) should ensure they have appropriate business associate agreements and compliance measures in place according to their specific regulatory requirements.

For sharing referral documentation with patients or specialists, you can use Papersign to generate secure, signable PDF versions of completed referrals, consent forms, or care coordination agreements, keeping everything connected to the original submission.

Professional, Patient-Centered Care Coordination

High-risk pregnancy referrals require both clinical precision and compassionate communication. This template helps midwives provide thorough documentation while maintaining the trust and continuity that's essential during vulnerable care transitions. The clear structure ensures referring and receiving providers have everything they need to make informed decisions and provide coordinated, patient-centered care.

Whether you're a solo midwife, part of a birth center team, or managing referrals for a large practice, this Paperform template gives you a professional, efficient way to facilitate high-risk obstetrics referrals while keeping the focus where it belongs—on optimal maternal and fetal outcomes.

Start with this template today and experience how Paperform can transform your clinical referral processes into streamlined, professional workflows that support excellent care coordination.