There are two ways to become enrolled as a doula with the CA Department of Health Care Services:
Experience Pathway
Have provided services in the capacity of a doula in either a paid or volunteer capacity for at least five years.
The five years must have occurred within the last seven years at the time the application is submitted.
Have 3 written client testimonials/letters of recommendation that meet the requirements described below.
Training Pathway
Have a Certificate of Completion with a minimum of 16 hours of training.
Have attended at least 3 births in the capacity as a birth doula.
This document focuses on the Experience Pathway, in particular guidelines for collecting 3 client testimonials/letters of recommendation.
Guidelines
One letter must be from either a licensed provider, a community-based organization, or an enrolled doula.
The other two may be either client testimonials or professional letters of recommendations from any of the following:
A physician
licensed behavioral health provider
nurse practitioner
nurse midwife
licensed midwife
enrolled doula
community-based organization
The letters must be written within the last seven years.
The letters MUST follow the following templates.
Templates
Please copy the following templates verbatim! The only parts that should be changed are the information in [brackets].
Testimonial Template for Clients
I, [client name] declare that the following is true and correct:
I was a client of [doula name].
I attest that I received services within the last five years from [doula name] and [doula name] has demonstrated the skills and experience in prenatal, labor, and postpartum care to work as a doula.
Name:
Business Address:
Telephone Number:
Signature and Date:
This information in your testimonial letter is requested by the Department of Health Care Services (DHCS), Provider Enrollment Division. This information will be used by DHCS to determine whether above named applicant qualifies for enrollment into the Medi-Cal program. California Welfare and Institutions Code section 14000, et seq. authorizes the maintenance of this information by DHCS.
The Chief of the Provider Enrollment Division, P.O. Box 997412, Sacramento, CA 95899-7412, (888) 452-8609, is responsible for the system of records and shall, upon request, inform you of the location of your records and the categories of any persons who use the information in those records. You have a right to access records containing personal information which are maintained by DHCS. If you would like to request a copy, please submit your request via the Provider Enrollment
Division online Inquiry Form at: PED Online Inquiry Form.
Submission of this information is voluntary. There are no consequences for not providing all or any part of this information.
Testimonial Template for Licensed Providers
Special Instructions: Testimonial letter must be on the licensed provider’s letterhead using the language below and contain no protected health or confidential information.
I, [provider name] declare that the following is true and correct:
1. I am a physician, psychologist, licensed marriage and family therapist,
licensed clinical social worker, licensed professional clinical counselor,
nurse practitioner, nurse midwife, or licensed midwife, as of the date of this letter of recommendation.
2. I attest that within the last five years (doula name) has demonstrated the skills and experience in prenatal, labor, and postpartum care to work as a doula.
Name and Title:
Business Address:
Telephone Number:
NPI:
Provider Type:
Signature and Date:
Testimonial Template for Community Organizations
Special Instructions: Testimonial letter must be on the community organization's letterhead using the language below and contain no protected health or confidential information.
Instructions: Testimonial letter must be on the community-based organization letterhead using the language below and contain no protected health or confidential information.
I, [name of community-based organization’s authorized representative] declare that the following is true and correct:
1. I am a community-based organization’s authorized representative.
2. I attest that within the last five years [doula name] has demonstrated the skills and experience in prenatal, labor, and postpartum care to work as a doula.
Name and Title:
Business Address:
Telephone Number:
Signature and Date:
Testimonial Template for Enrolled Doula
Special Instructions: Testimonial letter must be on the enrolled doula’s letterhead using the language below and contain no protected health or confidential information.
Note: An enrolled doula is a doula who has completed the DHCS PAVE Provider enrollment process.
I, (name of enrolled doula) declare that the following is true and correct:
I am a doula and am currently enrolled in the Medi-Cal program.
I attest that within the last five years (doula's name) has demonstrated the skills and experience in prenatal, labor, and postpartum care to work as a doula.
Name and Title:
Business Address:
Telephone Number:
NPI:
Signature and Date: