✨ Maternity Facility Access Agreement
24 APRIL
NEW ZEALAND GAZETTE
1137
APPENDIX II
ACCESS AGREEMENT
APPLICATION FOR ACCESS TO [NAME OF MATERNITY FACILITY OR FACILITIES]
Full name: .................................................................
Address: ....................................................................
Contact details: home phone, work phone, pager, cellphone, facsimile, email
..................................................................................
Professional qualification(s): ...................................................
Do you currently work for [name of Maternity Facility]? Yes / No
Name and address of two referees who can verify the identity of the applicant:
..................................................................................
..................................................................................
Attach a copy of your New Zealand Practising Certificate plus confirmation of your indemnity protection.
The information provided on this document is collected for the purpose of issuing and maintaining an Access Agreement and will not be used for any other purpose. You, as the applicant, confirm that all information provided is true and correct and that you agree to be bound by the terms and conditions of access for [name of Maternity Facility], a copy of which is attached.
Applicant’s signature ......................................................
Date: ........................................................................
Signed for and on behalf of [name of facility provider] ...........................
Position: .....................................................................
Date: ........................................................................
Status of Application: Approved / Declined
STANDARD TERMS AND CONDITIONS OF ACCESS TO A MATERNITY FACILITY OR BIRTHING UNIT
1.0 PURPOSE
The applicant ["the Practitioner"] is an Authorised Practitioner as defined by the Maternity Notice (2002) issued pursuant to Section 88 of the New Zealand Public Health and Disability Act 2000. The Practitioner has requested that [name of facility provider] ["the Maternity Facility"] grant the Practitioner access to the following facilities for the purpose of providing Labour & Birth and Inpatient Postnatal Care to the Practitioner's maternity clients.
[Name of facility/facilities] ....................................................
This Access Agreement provides the Practitioner with access to the services that are specified in the Maternity Facility service specification issued by the Ministry of Health on the terms and conditions set out in the following clauses.
2.0 OBLIGATIONS OF BOTH PARTIES
2.1 Cultural safety
i) Services to Māori will be provided in a way that is consistent with the Treaty of Waitangi, recognising the status of Māori as tangata whenua and the status of Māori women within the context of their cultural values, beliefs and practices.
ii) Maternity services will be provided in a manner that recognises cultural differences and is sensitive to the cultural traditions, protocols and customs of the woman.
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Online Sources for this page:
VUW Te Waharoa —
NZ Gazette 2002, No 40
Gazette.govt.nz —
NZ Gazette 2002, No 40
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Application for Access to Maternity Facility
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🏥 Health & Social WelfareMaternity, Access Agreement, Healthcare, Practitioner, Facility
🏥 Standard Terms and Conditions of Access to Maternity Facility
🏥 Health & Social WelfareMaternity, Access Agreement, Healthcare, Practitioner, Facility, Terms and Conditions