Initial Midwife to Family Nurse Partnership
Booking Visit / [Appendix 1]Mothers Name: / Date of Referral:
NHS No: / D.O.B: / Ethnicity:
Fathers Name: / D.O.B: / Ethnicity:
EDD: / Address:
Parity:
Postcode:
Name of Midwife: / Telephone No:
Mobile Number:
OK to send text messages to mobile No.?
Yes No
Midwife’s Contact No:
GP:
Midwife’s Base: / Is this person eligible for FNP? If so please indicate below
Yes No
The agreed criteria for women to be offered the FNP are that:
- All women are aged 19 and under at LMP and expecting their first baby.
- The programme is offered to women where previous pregnancies ended in miscarriage, termination, and stillbirth.
- FNP to be notified at booking by midwifeofALLeligible clients, clients to beenrolled with priority given to those under 16 week’s gestation (research based criteria). But no later than 24 weeks for enrolment before 28 weeks gestation (licensing and commissioningcriteria based on programme research).
Women are excluded from the programme if:
- They plan to have their child adopted.
- They have had a previous live birth.
Safeguarding referral completed: Yes No
CAF initiated: Yes No
If you are aware of any safeguarding issues please notify the Health Visitor
Does either parent have any reading/writing difficulties or learning needs?
(If yes please consider SPS referral) / Yes No
The referrer has gained verbal consent for:
This referral to be made
The sharing of information between professionals and services who are part of the Early Help Hub
The sharing of information with young parents services as appropriate – WILD and Young M ums Will Achieve
Should the woman have a miscarriage after booking appointment the midwife must notify the health visitor. A message should be left on the answer machine if there is no reply
Referrals should be emailed to the Early Help Hub
Telephone enquiries: 01872 322277 Monday to Thursday 8.45am to 5.15pm
Friday 8.45am to 4.45pm
Or visit the website www.cornwall.gov.uk/earlyhelphub