ILPQC OB Hospital Teams - Birth Certificate

The project team will work to develop, evaluate and improve a process. It is important to involve those who are directly working with the process. Include unit leaders, educators, and direct care providers who routinely work in the area. It is recommended to involve different disciplines (physician, nurse, etc.). Starred roles are required. The Project Team Leader can be (but does not have to be) the same person as the Physician Champion, Nurse Champion, or Birth Certificate Representative.

Question Title

* 1. Hospital Name

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* 2. Project Team Leader (Can be same as Physician Champion, Nurse Champion, or Birth Certificate Representative)

Name (Including Credentials)

Title/Position

Email Address

Direct Number

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* 3. Physician Champion

Name (Including Credentials)

Title/Position

Email Address

Direct Number

Question Title

* 4. Nurse Champion

Name (Including Credentials)

Title/Position

Email Address

Direct Number

Question Title

* 5. Birth Certificate Representative

Name (Including Credentials)

Title/Position

Email Address

Direct Number

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* 6. Quality Lead

Name (Including Credentials)

Title/Position

Email Address

Direct Number

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* 7. Other Team Member

Name (Including Credentials)

Title/Position

Email Address

Direct Number

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* 8. Other Team Member

Name (Including Credentials)

Title/Position

Email Address

Direct Number

Question Title

* 9. Other Team Member

Name (Including Credentials)

Title/Position

Email Address

Direct Number