Florida Keys Healthy Start Coalition

Pregnancy - Risk Screening

Ask your Doctor for a Healthy Start Prenatal Risk Screen

During your first visit with your OB/GYN or Midwife ask for the Healthy Start Prenatal Risk Screen. This is a simple one-page questionnaire that is completed by you and your Doctor or office staff.

Even if you don't have any problems, answering this questionnaire will be helpful in gathering the data that can improve health care for all of Florida's moms and babies.

How To Fill Out Your Healthy Start Prenatal Risk Screen:

1. Fill out the top portion of section one completely. Including:
- Your name
- Your contact information
- Your pregnancy history

2. It is very important that you check "YES" to the next question of "I am interested in being screened for Florida's Healthy Start".

3. Complete yes/no questions 1-13.

4. Check "YES" if you would like to participate in the Healthy Start Program.

5. Check "YES" to provide consent for release of information.

*** If you check "NO" to any of the questions listed in 2,4, or 5 above we will not be able to offer you services.

The second portion of the questionnaire is completed by your Doctor and submitted to Healthy Start.