Please complete the following questions and click submit
A. Was a clinical examination performed on the infant(s) by a physician, midwife/ or nurse?
B. Was the infant(s) found to be healthy after delivery?
A. Prior to giving birth, did your primary care physician, for this pregnancy, deem you healthy to have cord blood collected based on a physical exam?
B. Have any responses changed since you first completed the Medical History and Risk Assessment Questionnaire online at the time of registration? Refer to email sent at time of registration.
C. Delivery Type
D. Baby’s Gender
IMHS F15 64-0018
Effective Date: Jul.01, 2019
Subject to change without notice