Placenta Process Record – Encapsulation – Placenta Remedies Network

PRN Member email address (your form will be sent to this address) *

Client's name *

Any allergies noted on Booking Form? *

Yes, please noteYes, please note

Date of encapsulation *

Time of encapsulation *

Location of encapsulation *

Hands washed & Personal Protection Equipment worn (7.5) *

Yes

No, why?No, why?

Work space set up correctly (cleaned, disinfected, protected & supplies prepared) (7.1/7.12) *

Yes

No, why?No, why?

Equipment is clean, disinfected and in good working order prior to use (7.1) *

Yes

No, why?No, why?

Snap test completed - is the placenta completely dry? *

Yes

No - LEAVE FOR A FURTHER 2 HOURS

Encapsulation process followed (P4) *

Yes

No, why?No, why?

To confirm the following statements please tick those that apply *

Bottle/Jar used to hold capsules has been checked for damage, cleaned & dried thoroughly

Storage bag used to hold capsules is clean

Silica sachet is included with capsules

Labels are added to jar/bottle/bag

Storage information is included on labels

Dosage instructions are included on labels

Remedies are hand delivered

Remedies are posted for next day, signed for, deliver to client

OtherOther

Clean down & disinfect completed (7.1) *

Yes

No, why?No, why?

Waste management steps followed (7.11/A6) *

Yes

No, why?No, why?

Corrective action taken

Notes