S.I. No. 167/1934 - The Maternity Homes Regulations, 1934.

1. Name of applicant.

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2. Age of applicant.

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3. Nationality of applicant.

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4. Professional qualifications (if any) of applicant.

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5. Private address of applicant (if application is made on behalf of a company, society or other body, the address of the registered office or principal office of such company, society or other body, and the name and private address of the person or persons directly or indirectly responsible for the management of such company, society or other body should be given).

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6. If applicant has previously been connected with a maternity home give name and address of home, and particulars of applicant's connection therewith.

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7. Has applicant previously been refused registration in respect of a maternity home ?

If so give full particulars.

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8. If applicant has ever been reported to the Central Midwives' Board, 33 St. Stephen's Green, Dublin, for infringement of their regulations, give full particulars.

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Note—If applicant desires to be registered in respect of two or more maternity homes, a separate application must be made in respect of each home.

1

Insert name of Local Authority.

PARTICULARS

9. Has applicant ever been found guilty of an offence under :—

The Midwives Acts 1918 and 1931 ;

or

The

Registration of Maternity Homes Act, 1934

;

or

The Children Acts, 1908 to 1934 ;

or

The Prevention of Cruelty to Children Act, 1904 ?

If so, give full particulars.

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10. Name (if any) under which home or proposed home is to be carried on

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11. If the person in charge of the home is not the applicant the following particulars should be given in regard to her :—

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(a) Name in full.

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(b) Professional qualifications.

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(c) If she has been previously connected with a maternity home, give name and address of home, and particulars of her connection therewith.

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(d) If she has previously been refused registration in respect of a maternity home, give full particulars.

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(e) If she has ever been reported to the Central Midwives' Board, 33 St. Stephen's Green, Dublin, for infringement of their regulations, give full particulars.

(f) Has she ever been found guilty of an offence under :—

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The Midwives Acts, 1918, and 1931 ;

or

The

Registration of Maternity Homes Act, 1934

;

or

The Children Acts, 1908 to 1934 ;

or

The Prevention of Cruelty to Children Act, 1904 ?

If so, give full particulars.

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PARTICULARS

12. Particulars of staff to be employed permanently in the home :—

(a) Number of Qualified Nurses.

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(b) Number of Certified Midwives.

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(c) Number of Pupil Midwives.

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(d) Number of other persons, giving particulars of the capacity in which they are employed.

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13. Particulars of accommodation for staff.

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14. Number of patients for whom accommodation is provided in the home.

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15. Number of wards or bedrooms for patients in the home, giving floor area and number of beds in each.

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16. Special arrangements (if any) for dealing with puerperal pyrexia and sepsis.

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17. Sanitary accommodation provided in home.

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18. Is any other business carried on in same premises? If so, what ?

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19. Address of any other maternity home or homes in which applicant is interested, and nature and extent of such interest.

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Date

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Signature of Applicant

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FORM OF CERTIFICATE.

THE

REGISTRATION OF MATERNITY HOMES ACT, 1934

.

CERTIFICATE OF REGISTRATION.

The

1

............................................................ .................................... hereby certify that

2

............................................................ ............... of ............................................................ ......has been duly registered in respect of the maternity home carried on by such person at the premises known as

3

............................................................ ............................................................ ............................................................ .......................... in the register of maternity homes kept by the said local authority under the above-mentioned Act.

Given under the Common Seal of the

1

................................... this .................................... day of........................... 19......... in the presence of :—

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1

Insert name o Local Authority.

2

Insert name and private address of applicant registered.

3

Insert name (if any) and address of home.

FORM OF REGISTER.

REGISTRATION OF MATERNITY HOMES ACT, 1934

.

FORM No. 3.

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(INSERT NAME OF LOCAL AUTHORITY).

REGISTER OF MATERNITY HOMES

No.

Name (if any) of Maternity Home.

Address of Maternity Home.

Particulars of person or persons carrying on Maternity Home.

Particulars of person in charge of Maternity Home.

Staff employed in Maternity Home.

Particulars of Accommo

dation for Staff.

No. of patients for whom Accommodation is provided in Maternity Home.

Particulars of Wards or Bedrooms in Maternity Home.

Arrangements for dealing with Puerperal Pyrexia or Sepsis.

Sanitary accommo

dation in Maternity Home.

Particulars of any other Home in which person named in Column 4 is interested.

No.

Name.

Age.

Private Address.

Nation-

ality.

Professional Qualifications.

Previous record (if any).

Name.

Professional Qualifications.

Previous record (if any).

Qualified Nurses.

Registered Midwives.

Pupil Midwives.

Others.

Description of Ward or bedroom.

Floor space.

No. of beds.

Name of Home.

Address of Home.

Extent of Interest.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

(26)

(27)

FORM OF RECORDS AND PARTICULARS.

REGISTRATION OF MATERNITY HOMES ACT, 1934

.

FORM No. 4.

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(INSERT NAME (IF ANY) AND ADDRESS OF HOME).

No. Particulars of patient to be entered on reception into the Home. Medical Attendant (if any) of patient while in Home. Confinement and Birth in Home. Miscarriage in Home. Death in Home. Discharge of Mother from Home. Removal of Child from Home. Confinement. Birth. Name. Address. Age. Date of reception. Condition on reception Number of previous pregnancies.(Full time or otherwise). Name of patient's husband. Occupation of patient's husband. Name. Address. Date and hour. Delivery normal or abnormal. If abnormal, give particulars. Whether sepsis or other complication developed.If so, give particulars. Sex of infant. Weight of infant at birth. Full time or premature. If premature state degree of prematurity. Whether born alive or stillborn. Date and hour of miscarriage. Period of pregnancy. Contributing cause (if any) of miscarriage. Whether mother or infant. Date and hour of death. Cause of death. Date of discharge. State of health on discharge. Date and hour of removal. Particulars of person removing child. Particulars of person to whose care child is removed. No. Name. Address.Relationship (if any). Name.Address.Relationship (if any).(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) (29) (30) (31) (32) (33) (34)

STATUTORY RULES AND ORDERS. 1934. No. 167.

THE MATERNITY HOMES REGULATIONS, 1934.

DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH.

THE

REGISTRATION OF MATERNITY HOMES ACT, 1934

.

THE MATERNITY HOMES REGULATIONS, 1934.

The Minister for Local Government and Public Health in exercise of the powers vested in him by

Section 14

of the

Registration of Maternity Homes Act, 1934

, does by this Order, make the regulations hereinafter appearing in relation to matters or things referred to in the said Act as prescribed, that is to say :—