Stork Pin request

Stork Pin Request

Please complete all sections of the form in order to process your request.
The Stork Pin is an EMS tradition awarded to EMS staff to celebrate their first out of hosptial delivery of a baby.

Staff who are awarded this pin may wear it on their uniform. For proper placement please see the Uniform Etiquette Policy, Section 3.4, ‘Lapel Pins’, on www.ahsems.com.

Inclusion criteria:

• EMR, PCP, or ACP practitioners directly involved in an out of hospital birth are eligible to receive one stork pin, one time only;

• Attending the call after the birth and /or providing post-natal care and transport for the mom and/or baby does not meet criteria; i.e.: babies born prior to EMS arrival or after transfer of care in hospital do not meet criteria;

• Pins will be awarded to direct delivery AHS EMS staff and their students only (if applicable).

Questions? Please email ems.peo@ahs.ca for more information.
Name*

First NameLast Name
Email*
example@example.com
Supervisor*
Event Number *
Other staff that assisted with the out of hospital delivery and are eligible for a stork pin (partner, orientee, student)
Is there anything else you'd like to add?
Should be Empty:

Stork Pin Request