NJ Safe Haven Medical Questionaire

no shame.no blame.no names.

Safe Haven►Allowsadistressedparenttogiveupanunwantedinfant

safely,legallyandconfidentially

►Protectstheparentfromarrestorprosecutionforabandonment

►Requiresnonamesorrecords

►Permitsbabiesupto30daysoldtobegivenupatanyhospitalemergencyroom,policestation,firedepartment,ambulance,firstaid,orrescuesquad

►Makesmedicaltreatmentandsocialservicesavailableto thebirthmother-confidentially

►PutsthechildintothecustodyofChildProtectionandPermanency,whichplacestheinfantinafosteror

pre-adoptivehome

Certainly we would prefer that women call us while they arepregnant,notaftergivingbirth,sowecanprovidepropermedicalcareandcounseling.Butat thesametime,wewant toassureparentswhochoosenottokeeptheirchildrenthattheywillnotgoto jail if theydeliver theirbabiestosafehands inahospitalemergencyroom,policestation,firedepartment,ambulance,firstaid,orrescuesquad.

In New Jersey, no one ever has to abandon a child again.

Safe Haven Hotline: 1-877-839-2339

njsafehaven.org

1-877-839-2339

New Jersey has a safe haven for unwanted infants.

Anonymously surrender the baby to any hospital E.R., police station, fire department, ambulance,

first aid, or rescue squad.

These Numbers Can Also Help:

Call211orvisitwww.nj211.orgtoconnectwithsocialserviceagenciesinyourcommunity.

ParentsAnonymousofNewJerseyFamilyHelpline1-800-THEKIDS

DomesticViolenceHotline1-800-572-SAFE

ChildAbuseHotline1-877-NJABUSE

Safe Haven Voluntary Medical Information UndertheSafeHavenlaw,youdonothavetotellusanything,butansweringthesequestionswillhelpustakebettercareofthechild.Pleasefilloutthisformwithanyinformationyouwanttoshare.Thengiveittosomeoneinthehospitalormailitin.Nostampisrequired.Please tell us what you can about the baby:Sincebirth,hasthebabybeensick? yes no don’tknowAnyphysicalhandicaps? yes no don’tknowAnymentalordevelopmentalproblems?(forexample,thebabynevercriedorhastroublesucking) yes no don’tknowIfyouansweredyestoanyofthesequestions,pleasegivedetails:

Waschildgivenaname? yes no don’tknowIfyes,pleasegiveonlythechild’sfirstand/ormiddlename:

Dateandplaceofbirth?

Whatisthechild’srace?Religiousorculturalbackground?

Didmotherreceivemedicalcareduringherpregnancy? yes no don’tknowDeliveredinahospitalorbirthingcenter? yes no don’tknowWasthebabyfullterm(9months)? yes no don’tknowIfnot,howlongwasthemotherpregnant?Whatwasthebirthweight?pounds,ouncesWhyisthechildbeinggivenup?

Mother’s medical history: Ifmotherhasotherchildren,howmany?Raceofmother:Ageofmother:Didmothereverhaveaseriousmedicalproblem?(heartdisease,bloodpressure,diabetes,cancer,etc.) yes no don’tknowHistoryofmentalillness? yes no don’tknowHIV-positive? yes no don’tknowDrugoralcoholabuse? yes no don’tknowIfyes,wasitduringthepregnancy? yes no don’tknowIfyouansweredyestoanyofthesequestions,pleasegivedetails:

Father’s medical history:Raceoffather:Ageoffather:Didfathereverhaveaseriousmedicalproblem?(heartdisease,bloodpressure,diabetes,cancer,etc.) yes no don’tknowHistoryofmentalillness? yes no don’tknowHIV-positive? yes no don’tknowDrugoralcoholabuse? yes no don’tknowIfyouansweredyestoanyofthesequestions,pleasegivedetails:

HowdidyoulearnaboutSafeHaven?

THANK YOU FOR SHARING THIS INFORMATION

What is Safe Haven?It’s a law: theNew JerseySafeHaven Infant ProtectionAct.Under this law a person may give up an unwanted infantanonymously. As longas thebabyhasnotbeenabused, thepersonmaydosowithoutfearofarrestorprosecution.

Why does New Jersey do this?ThepurposeofSafeHavenistoprotectunwantedbabiesfrombeinghurtorkilledfromunsafeabandonment.Abandoning a baby puts the infant in extreme danger. Toooften,itresultsinthebaby’sdeath.Itisalsoillegal,withsevereconsequences.ButwithSafehaven,thistragedydoesn’thavetohappeneverinNewJersey.

How does it work?Adistressedparentwhoisunabletocareforaninfantcangiveupcustodyofababy less than30daysoldsafely, legallyandanonymously. All that is required is that the baby be broughtto a hospital emergency room, police station, fire department,ambulance,firstaid,orrescuesquadinNewJersey.Aslongasthechildshowsnosignsofintentionalabuse,nonameorotherinformationisrequired.

Can only a parent bring in the baby?No.Theparentmaychoosetohavesomeoneelsebringintheinfant.Itcanbeafamilymember,afriend,aclergymember,asocialworker-practicallyanyone.

Do you have to call before bringing in the baby?No.Youcanwalkinanytime.

Can you help a parent decide where to bring the baby?Yes.TheparentcancalltheSafeHavenHotline1-877-839-2339andgettheaddressanddirectionsforanyhospital,policestation,firedepartment,ambulance,firstaid,orrescuesquadinthestatethatarestaffed24hoursaday,sevendaysaweek.

Does a parent have to tell anything to the people taking the baby?No.Nothingisrequired.However,anyinformationthataparentiswillingtoshare,suchasthechild’shealth,race,dateofbirth,placeofbirthormedicalhistoryoftheparentswillberecorded.Thiscouldbeveryusefulincaringforthechild.ThesequestionscanbeansweredanonymouslyonamedicalquestionnairethatisavailableattheSafeHaven.

What happens if a woman voluntarily provides her personal identifying information to hospital staff while delivering her baby at the hospital or being admitted?If a woman voluntarily provides her personal identifyinginformation to hospital staffwhile delivering her babyor beingadmitted, her anonymitywill no longer beprotectedunder theNewJerseySafeHavenLawandtheStatewillhavethemandatetosearchforandcontacttheinfant’sfatherand/orrelatives.

What happens to the mother when she drops off a baby?If the mother brings in the baby, she will be offered medicaltreatmentandsocialservices.Shecan,ofcourse,refuseifshewishes.Onceshehassafelyturnedoverthebaby,sheisfreetogo.Shecancompleteananonymousmedicalquestionnaireanddropitinanymailbox.

What happens to the baby once the baby is dropped off?Thechildwillbeexaminedandgivenmedicaltreatment,ifneeded.ThenChildProtectionandPermanency(CP&P)willimmediatelytakecustodyandplacethechildinafosterorpre-adoptivehome.After21days,CP&Pwillproceedwiththepermanentadoptionofthebaby.Therearealwaysmanyfamiliesavailablewhowanttoadoptaninfant.

What happens if the mother, or a relative, wishes to regain custody of a baby?Ifthemother,orarelative,wishestoregaincustodyofthebabytheyshouldcontacttheSafeHavenHotlineat1-877-839-2339sothattheycanbegintheprocesstowardsasafereunification.

Don’t let another baby be abandoned. If you or someone you know is considering giving up a child, learn about your options.

Safe Haven Hotline1-877-839-2339