Forms and Guide
Massachusetts Health Care Proxy – The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions.
Completed forms are to be sent to: Admitting Department. Newton-Wellesley Hospital. 2014 Washington Street. Newton, MA 02462-1699
Maternity Pre-Admission Form – NWH Maternity form to gather patient identification, insurance information, and race / ethnicity information.
Labor and Deliver Patient Admission Data Form – Pre-admission form for Labor and Delivery.
Birth Plan Worksheet: Your Approach to Birth – Worksheet for patient to communicate birth experience preferences.
Congratulations on your pregnancy! As you may know, Massachusetts requires that Newton-Wellesley Hospital collect certain information about you, your partner and your baby. This information is confidential. During your hospital stay a Birth Registry staff member will visit you and collect the required information.
To reduce the amount of time the Birth Registry staff member will spend with you, complete the “Mandatory Birth Reporting Form Certificate” form at least 10 days prior to your anticipated hospital stay. Once you have completed the worksheet mail it back to Newton-Wellesley Hospital.
Birth Registry Office 5 West
Newton-Wellesley Hospital
2014 Washington Street
Newton, MA 02462
A completed, accurate birth certificate worksheet is needed for:
- the option to apply for a social security card for the child during your hospital stay
- to receive an insurance letter for benefits
- to be granted access to government benefits
Please take care to complete this form carefully and completely as it may be difficult and costly to make corrections or changes after a birth certificate has been completed. Therefore, accuracy of information given is very important.
If you have questions about the information that is collected or problems obtaining a copy of the birth certificate from Newton City Hall, please contact the Massachusetts Registry of Vital Records and Statistics (RVRS) at 617-740-2623. Thank you for your cooperation!