Disclaimer: This form is private and confidential in accordance with HIPAA Compliance. It is designed to securely collect your information and documents as part of the onboarding process to become a Abortion Doula provider with Birthworkers of Color Collective.

We have outlined the steps and processes to complete your enrollment. Please note that ALL steps must be completed in its entirety and promptly to avoid processing delays.

We look forward to working with you in providing compassionate, non-judgemental support and affirming care for our community members navigating abortion.

In solidarity,

Stevie Merino

Co-Founder & Executive Director

Please review the required training and document checklist below. Please make sure you have all of these documents available before you begin the onboarding process. Please plan 45 minutes to one hour to complete onboarding form. 

Requirements Checklist:

• Review onboarding video (19 minutes)
• Your contact information.
• Proof of Completion of Abortion Doula Training
• Proof of Completion of HIPAA Training
• Acknowledgment you reviewed Confidentiality, Privacy, and Cybersecurity Training (14 minute video)
• Acknowledgement of Review and Understanding and Compliance with BWOCC Reporting and Billing Requirements (15 minute training video)

You will need to attest that you have met these requirements by completing the following steps:

• Provide your contact information.
• Sign the attestation confirming that you have met the requirements.
• Upload all required documents.

ONBOARDING VIDEO (19 min)

By checking the boxes above, I attest that I have the necessary documents.  I understand that providing false information or failing to provide all required documents may result in delays in the onboarding/approval process. 

Objective
Equip abortion doulas with the knowledge and tools to protect the privacy and safety of abortion seekers and themselves while navigating a digital landscape with growing risks.

Please review the following

• Abortion Doula Program Security and Safety Training Video (14 minutes)
• Abortion Doula Program Security Resource List

Please review the following

Abortion Doula Program Reporting and Billing Requirements Training (15 minutes)

1. I will ensure that all client intake forms are completed and signed in their entirety before rendering services and submitting claims.
2. I will complete Doula Reporting Form in their entirety and submit them within 24-72 hours of the date of the appointment.
3. I will not backdate past client support sessions. 
4. I will submit valid invoices with my doula reporting forms and track my payments and services. 
5. I understand that failure to follow these protocols may result in delays in claims getting processed and paid and corrective action, up to and including the termination of my affiliation with Birthworkers of Color Collective.

Disclosures will include:

• Independent subcontractor agreement via HIPAA JotForm Link: This document covers the terms of your relationship under Birthworkers of Color Colective to provide Doula support services to community members, payment schedules, etc.
• Information Request Form via HIPAA JotForm: This document requests your contact information, preferred method of contact, Social Security Number, Demographic information.
• Code of Conduct Form via HIPAA JotForm Link
  
  

• You will receive an email to schedule a 1-on-1 training session, which will include links to training videos and Abortion Resources
• Attend 1-on-1 training including understanding the expectations on how we serve our clients, along with best practices.
• Receive your invitation to the BWOCC Communication Channel
• Confirm your invitation

You will receive an email to register for Gusto, where you can view your payment information and tax documents.

If you have any questions regarding the enrollment process please contact: 

Christina Lares

christina@birthworkersofcolor.com