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Sample Affiliate Peer Review Program

To facilitate the implementation of this sample ACNM Affiliate-based peer review program, the documents on this page may be downloaded as needed.  Please note that affiliates and individuals are advised to consult their state laws and regulatory guidelines related to peer review, and to seek legal counsel to ensure that the process they develop complies with all applicable state and local laws and regulations, and is structured to comply with the applicable protections, if any, for nonphysician peer reviewers.

Philosophy, Purpose, and Objectives

Methodology

Procedure

Guidelines for Statistical Reporting

Peer Review Statistical Summary

Review of Practices with Segmental Care Services

Segmental Care Services - Intrapartum Care

Segmental Care Services - Outpatient Prenatal Care

Guidelines for Reviewers - General

Guidelines for Reviewers - Chart Review

Peer Review Check List - Practice

Peer Review Check List - Antepartum

Peer Review Check List - Intrapartum

Peer Review Check List - Postpartum

Peer Review Check List - GYN

Guidelines for Financial Reimbursement of Reviewers

Application for Participation

Initial Response to Request for Review

Confirmation Letter

Certificate of Peer Review

Confidentiality Statement