Massachusetts General Laws Part I. Administration of the Government (Ch. 1-182) Ch. 112, § 296

When accepting a client for care, a licensed certified professional midwife shall obtain the client's informed consent, which shall be evidenced by a written statement in a form prescribed by the board and signed by both the licensed certified professional midwife and the client. The signed form shall be included in the client's record of care. The form shall include, but not be limited to, the following: (i) an acknowledgement that the licensed certified professional midwife is not authorized to practice medicine; (ii) a description of written practice guidelines, services provided and the risks and benefits of birth in the client's chosen environment; and (iii) disclosure that the client may be referred for a consultation with or have their care transferred to a physician if the client requires care that is outside the midwife's scope of practice.