Information
Demographics
Information
Implementation
Organization Information
Additional Organization Information
Clinical Champions
Administrative Champions
Patient Demographics
Race/Ethnicity*
Age and Risk*
Insurance Coverage*
What Languages are Spoken by your Patients?
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Provider Information
Number of Obstetrical Service Staff*
Program Implementation and Site Operation
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Terms and Conditions
By registering to access the Supportive Pregnancy Care materials provided on this website, you will be granted access for two years from today’s date. In order to gain and maintain access to the materials provided on this website, you agree to the following:
Data and Reporting: As a Supportive Pregnancy Care Project, Provider will be required to submit group data to the Manager of Supportive Pregnancy Care™. The Provider offering Supportive Pregnancy Care™ services under this agreement must comply with data reporting requirements set forth by the March of Dimes; provided, however, under no circumstances shall Provider be required to submit any identifiable patient information that is protected by any applicable law including, but not limited to HIPAA.
Provider must complete a set of data reporting forms that includes enrollment data, status of ongoing groups, and outcomes data. The Group Data Worksheet is required for every group that meets during the project period, even if the groups end up to six months following the agreement period. Any such data shall be de-identified so as not to violate any legal protections of patient confidentiality.
Provider is required to participate in quarterly reporting, providing a written report using the template provided, due 30 days after the end of the quarter, to share overall successes and challenges. Provider will submit to March of Dimes additional reports that we reasonably request and cooperate with us in connection with the Project. March of Dimes may make visits to the project site, to be scheduled in advance.
Intellectual Property Ownership. The March of Dimes expressly reserves for itself any and all ownership rights, title, and interest in and to the Supportive Pregnancy Care™ name and program, its program-related materials and implementation tools, and all other materials MOD may supply to Provider or otherwise developed by MOD in connection with the Project (the “SPC Program Materials”).
The March of Dimes grants Provider the revocable, non-sublicensable, non-exclusive right to reproduce and distribute the SPC Program Materials, solely as needed in connection with the Project and only for the term of this Agreement. Provider may not alter or modify the SPC Program Materials in any respect without prior written approval of MOD. All other rights in connection with the SPC Program Materials are expressly retained by the March of Dimes, including but not limited to the right to prepare derivative works.
If you do not comply with the above requirements, your access to this portal will be terminated.