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Participation in France-Périnat Network

If you want to participate in France-Périnat Network, that is to say to share the personal data of the patients who have given birth in the maternity unit or of the newborns hospitalised during one month every year or during the whole year, please fill in the following form

Identification     * Required fields   Title: Dr Pr Mrs Miss Mr *   Last name: *   First name: *   Maternity unit:     Number of childbirths per year:   Neonatology service     Number of hospitalised children per year       Address: *   Zip code: *   City: *   Tel: *   Fax:   E-mail (personal or professional) : *       Complementary data       Do you use a structured obstetrical file: Yes No   If yes: Common AUDIPOG file Common AUDIPOG file Minimum AUDIPOG file Another structured file        If you use another file, which one:   If not, would you choose such a file: Yes No        Which one: >>> Display the AUDIPOG files       Do you have a computerisation of the medical data: Yes No   If yes, which software do you use:   If not, Do you foresee to acquire such a software : Yes No   Which one: >>> display the list of softwares labeled "AUDIPOG"       Who is in charge of informatization in your service?   Last name:   First name:   Tel:   Fax:   E-mail (personal or professional) :     Participation in France-Périnat Network       I would like to participate to the Sentinelle Network: Yes No   By sending a copy of the computer file of the service   - participation one month per year the whole year   By capturing data on the AUDINET capture module   - participation for a month   By capturing data on the AUDIPOG website   - 3 ways to have access to the site   Obstetrical minimal file Obstetrical-pediatric minimal file Neonatal minimal file only   - participation one month per year the whole year   By manual data capture on paper sheets, while waiting for computerisation   - 2 types of files are available   Minimal obstetrical sheet Minimal obstetrical-pediatric sheet   - Participation formonth   - number of sheets you want       Write the result in FRENCH and in CAPITAL LETTER :