This form is to assess your needs to become eligible for Medicaid reimbursement.

Here’s the link to the application to be eligible, it's a $75 fee - https://www.decertboard.org/doula

Thank you for your participation! If you would like to connect with other Black doulas in Delaware and share resources, links, and updates, please join the black doula discord chat using this link:

and become a member of Delaware's Black Reproductive Justice Coalition: https://www.deblackdoulas.org/

First Name *

Last Name *

Pronouns:

Email *

Phone *

Do you have your doula certification? *

Yes

Do you have your CPR Certification? Here is the link to a local CPR course, the cost is $85: https://www.myskeeper.com/

Yes

Do you have currently have 3 clients where you were the primary doula? *

Yes

If yes to previous question, please fill out the following client evaluation form: file:///C:/Users/sndarby/Downloads/DE%20doula%20evaluation%20documents%20(1).pdf

Do you have liability insurance? Here is a recommended company: https://www.cmfgroup.com/professional-liability-insurance/maternity-birth-professional-insurance/doula-insurance/?fbclid=IwAR0dhCHeUU5WswyLZgfHrYy2UaB4xqjxPliOQQwEZdYM-l_c2hWqD3lyPqc *

Yes

Do you currently have a NPI #? *

Yes

If answered no to previous question, please apply for a free NPI # here: https://nppes.cms.hhs.gov/

Have you had your fingerprint and background check? Please use this link to do so: https://uenroll.identogo.com/ The service code is 27RVGT *

Yes

Have you had your HIPPA training? Cost: $10 - https://blxtraining.com/course/hipaa-health-insurance-portability-and-accountability-act-dental/?fbclid=IwAR2H0wBPX9nYE4tUaXaMKCLQf8ihNp91d7X0lgZb92-0K9dkZeKICYrqtWk *

Yes

Do you need a notary? *

Yes

Do you need BMIP to cover any of the following costs: *

Application Fee

CPR Training

HIPPA Training

Fingerprints/background check

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.