Kensington Midwives - Intake Form

The Ministry of Health and Long-Term Care – which provides funding for the Ontario Midwifery Program – would like to obtain information regarding the demand for midwifery services around the province.

To help the Ministry get the information it needs, we have agreed to ask individuals we are unable to be accommodated at our Practice Group whether they would be willing to provide some basic personal information and consent to the disclosure of this information – specifically, name, birth date, postal code, and expected date of birth. This information will be collected through the Better Outcomes Registry and Network (BORN), a prescribed registry that collects information related to maternal, infant and child health. BORN also administers the Midwifery Invoicing System on behalf of the Ministry. The Ministry needs this information in order to properly conduct a study that will assist in future planning for midwifery services across the province.

You should know that:

• the Ministry will not receive your personal information and will only receive de-identified, aggregated data;

• BORN will receive your personal information only if you consent to this disclosure;

• you are under no obligation to provide this information, and if you do not consent, this will have no effect on your eligibility to receive midwifery care in the future; and

• BORN, on behalf of the Ministry is collecting this information solely for the purpose of conducting a study to assess the demand for midwifery services in the province, and will use it for no other purpose.

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