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(i) name;

(ii) medical record number;

(iii) address on admission;

(iv) date of birth; and

(v) marital status;

(B) the date of admission;

(C) the name, address, and telephone number of a contact person;

(D) proof that the birth center provided the client a complete orientation in accordance with 7 AAC 12.403(d);

(E) a plan for payment for services;

(F) the client’s social, family, medical, reproductive, nutritional, and behavioral history;

(G) the results of an initial physical examination;

(H) the results of a risk assessment conducted upon admission in accordance with the standards developed under 7 AAC 12.403(f);

(I) evidence of appropriate referral for an ineligible client, including the report completed during initial screening;

(J) the results of continuous periodic prenatal examination, including evaluation of risk factors and risk status in accordance with the standards developed under 7 AAC 12.403(f); and

(K) information regarding instruction and education provided, including nutritional counseling, changes in pregnancy, self-care in pregnancy, orientation to health records, understanding of findings on examinations and laboratory tests, preparation for labor, sibling preparation, and newborn assessment and care;

(2) an order sheet that includes medication and treatment, signed by a midwife or another practitioner who ordered the medication or treatment;

(3) notes entered by the clinical staff, including

(A) an accurate record of care given;

(B) a record of pertinent observations and responses to treatment of the client including psychosocial and physical manifestations;

(C) an assessment at the time of admission;