Placenta Process Record – Placenta Essence

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

Meconium present (double check on Placenta Release Form) *

Yes

Any other physical contaminants present? *

Yes, complete 'corrective action taken' box below

Date of processing essence *

Time of processing essence *

Temperature of placenta prior to processing (if not under 8°c then note in corrective actions taken box below) *

Location essence is being processed at *

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?

Placenta essence process (P5) followed *

Yes

No, why?No, why?

Placenta steeped for maximum 4 hours before removing placenta and adding strong alcohol *

Yes

No - corrective action taken?No - corrective action taken?

Alcohol used is minimum 40% ABV *

Yes

No - corrective action taken?No - corrective action taken?

Clean down & disinfect completed (7.1) *

Yes

No, why?No, why?

Waste management steps followed (7.11/A6) *

Yes

No, why?No, why?

To confirm the following statements please tick those that apply *

Bottles used to hold essence have been checked for damage, cleaned and dried thoroughly

Storage bag used to hold essence is clean

Labels are added to bottles

Storage information is included on labels

Dosage information are included on labels

Remedies are hand delivered

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

OtherOther

The Client/birth partner has been made aware of the following (please tick) *

Essence should not be consumed within the first 24 hours of processing

Any other stipulations?Any other stipulations?

Corrective action taken

Notes